Provider Demographics
NPI:1063127686
Name:NATHAN, PHOEBE (CSW-INTERN)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:CSW-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10167 MONKS HOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7394
Mailing Address - Country:US
Mailing Address - Phone:507-340-5001
Mailing Address - Fax:
Practice Address - Street 1:7000 SPRING MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3816
Practice Address - Country:US
Practice Address - Phone:702-873-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6633-M1041C0700X
NVIC-17181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical