Provider Demographics
NPI:1194130187
Name:MISSEN, NATHAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:MISSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 STRACHAN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2836
Mailing Address - Country:US
Mailing Address - Phone:724-970-4851
Mailing Address - Fax:
Practice Address - Street 1:2702 STRACHAN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2836
Practice Address - Country:US
Practice Address - Phone:724-970-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool