Healthcare Provider Details

I. General information

NPI: 1336810084
Provider Name (Legal Business Name): NATHANIEL HELTSLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 31W BYPASS SUITE G
BOWLING GREEN KY
42104-4968
US

IV. Provider business mailing address

5966 SCOTTSVILLE RD STE 3
BOWLING GREEN KY
42104-7908
US

V. Phone/Fax

Practice location:
  • Phone: 364-203-9250
  • Fax: 270-713-0007
Mailing address:
  • Phone: 270-904-5104
  • Fax: 270-201-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number265425
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number258207
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: