Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
Y | 103K00000X | Behavior Analyst | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TH0100X | Health Service | ||
N | 174V00000X | Clinical Ethicist |
NPI | 1922470947 |
---|---|
Provider Name | Dr. Nathan Church |
First Address | Hemet, CA 92545-6844 |
Second Address | Palm Desert, CA 92260-9342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2015 |
Last Update Date | 29/10/2015 |