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General NPI Number Information
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NPI Number | 1497487797
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Entity Type | Individual
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Provider Name | NATHAN BROCKMEYER LCPC
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 120 S HAYS ST SUITE 300
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City | BEL AIR
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State | MD
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Zip | 21014-0797
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Country | US
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Telephone | 443-752-4287
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Fax |
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Provider Business Mailing Address
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Address Line | 3961 OLD FEDERAL HILL RD
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City | JARRETTSVILLE
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State | MD
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Zip | 21084-1633
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Country | US
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Telephone | 443-752-4287
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC12789
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License Number State | MD
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