Healthcare Provider Details

I. General information

NPI: 1265395701
Provider Name (Legal Business Name): NATHANIEL ALAN BEECHLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 S HAM LN STE A&B
LODI CA
95242-3059
US

IV. Provider business mailing address

541 S HAM LN STE A&B
LODI CA
95242-3059
US

V. Phone/Fax

Practice location:
  • Phone: 209-553-0798
  • Fax:
Mailing address:
  • Phone: 209-553-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: