Basic Information
| Provider Information | |||||||||
| NPI: | 1447674361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | NATHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 26TH ST | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844013105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016253700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2661 WASHINGTON BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844013606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016218670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 12/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 8760003008007 | 05 | UT | MEDICAID | 000055266 | 01 | UT | MEDICARE PIN | OTHER | 260022408 | 01 | UT | RAILROAD MEDICARE | OTHER |