Provider Demographics
NPI:1285967794
Name:NATHAN HOOVER PA
Entity type:Organization
Organization Name:NATHAN HOOVER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MED
Authorized Official - Phone:806-239-1438
Mailing Address - Street 1:2526 82ND ST
Mailing Address - Street 2:A7
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2223
Mailing Address - Country:US
Mailing Address - Phone:806-239-1438
Mailing Address - Fax:806-771-2717
Practice Address - Street 1:2526 82ND ST
Practice Address - Street 2:A7
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2223
Practice Address - Country:US
Practice Address - Phone:806-239-1438
Practice Address - Fax:806-771-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19059101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1669152-03Medicaid