Healthcare Provider Details

I. General information

NPI: 1164084380
Provider Name (Legal Business Name): NATHAN T HUGHES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E ROUTT AVE
PUEBLO CO
81004-2122
US

IV. Provider business mailing address

2233 ACADEMY PL STE 200
COLORADO SPRINGS CO
80909-1666
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-4066
  • Fax:
Mailing address:
  • Phone: 719-597-0822
  • Fax: 719-599-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89715
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: