Provider Demographics
NPI:1952986952
Name:PETTIT, NATHAN SAMUEL (MS, LMHC, MCAP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:SAMUEL
Last Name:PETTIT
Suffix:
Gender:M
Credentials:MS, LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 LAURENTINA LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5280
Mailing Address - Country:US
Mailing Address - Phone:239-240-2121
Mailing Address - Fax:
Practice Address - Street 1:2442 LAURENTINA LN
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5280
Practice Address - Country:US
Practice Address - Phone:239-240-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
FL22796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)