Basic Information
| Provider Information | |||||||||
| NPI: | 1528332434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN SLOCHTEREN | ||||||||
| FirstName: | NATHEN | ||||||||
| MiddleName: | TYLER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 182 SW ACADEMY ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973381900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036231886 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 182 SW ACADEMY ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973381900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036231886 | ||||||||
| FaxNumber: | 5036237560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2012 | ||||||||
| LastUpdateDate: | 02/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.