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General NPI Number Information
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NPI Number | 1093282592
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Entity Type | Individual
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Provider Name | NATHAN GREGORY MAUST LCPC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 3231 CHESTNUT RIDGE RD
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City | GRANTSVILLE
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State | MD
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Zip | 21536-1370
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Country | US
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Telephone | 301-450-7274
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Fax | 301-238-8044
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | GRANTSVILLE
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State | MD
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Zip | 21536-0055
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Country | US
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Telephone | 301-450-7274
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Fax | 301-238-8044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LGP8709
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License Number State | MD
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