Healthcare Provider Details

I. General information

NPI: 1033013867
Provider Name (Legal Business Name): DR NATE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8256 S CHEROKEE ST
TERRE HAUTE IN
47802-5014
US

IV. Provider business mailing address

8256 S CHEROKEE ST
TERRE HAUTE IN
47802-5014
US

V. Phone/Fax

Practice location:
  • Phone: 727-537-6693
  • Fax: 812-803-1647
Mailing address:
  • Phone: 727-537-6693
  • Fax: 812-803-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. NATHANIEL WAGNER
Title or Position: OWNER
Credential: PHD
Phone: 812-370-0370