Healthcare Provider Details

I. General information

NPI: 1780137141
Provider Name (Legal Business Name): NATHAN AISH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 12/12/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 TECATE RD SUITE 2G
TECATE CA
91980
US

IV. Provider business mailing address

PO BOX 369 #998
TECATE CA
91980
US

V. Phone/Fax

Practice location:
  • Phone: 619-259-0676
  • Fax:
Mailing address:
  • Phone: 619-952-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number100849
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW62577
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100849
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number100849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: