Provider Demographics
NPI:1104566603
Name:O'BEAR, NATHANIEL RYAN (DBA, BCBA)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:RYAN
Last Name:O'BEAR
Suffix:
Gender:M
Credentials:DBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 PERKINS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-6465
Mailing Address - Country:US
Mailing Address - Phone:309-331-0848
Mailing Address - Fax:
Practice Address - Street 1:1213 PERKINS MILL RD
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-6465
Practice Address - Country:US
Practice Address - Phone:309-331-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB649630106S00000X
1-23-67731103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician