Provider Demographics
NPI:1851253926
Name:NOURISH PSYCHOLOGY LLC
Entity type:Organization
Organization Name:NOURISH PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-929-4593
Mailing Address - Street 1:1257 MERRIMACK DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-4159
Mailing Address - Country:US
Mailing Address - Phone:812-929-4593
Mailing Address - Fax:812-961-6551
Practice Address - Street 1:1257 MERRIMACK DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-4159
Practice Address - Country:US
Practice Address - Phone:812-929-4593
Practice Address - Fax:812-961-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty