MEDICARE: DR. STUART JOEL NATHAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	23367	TX
2	103T00000X	Psychologist	23367	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
13	680001954	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	23367	OTHER	TX	MOLINA/COMPCARE
3	23367	OTHER	TX	TRICARE
4	4526527	OTHER	TX	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	23367	OTHER	TX	LIFESYNCH HUMANA
7	23367	OTHER	TX	MAGELLAN
8	23367	OTHER	TX	APS
9	23367	OTHER	TX	MHN
10	23367	OTHER	TX	MULTIPLAN/PHCS
11	23367	OTHER	TX	RENNASCIANCE
12	23367	OTHER	TX	UBH
14	00B06A	OTHER	TX	BCBS
15	026280	OTHER	TX	VALUE OPTIONS
16	10019555	OTHER	TX	AMERIGROUP
17	23367	OTHER	TX	GREAT WEST
18	23367	OTHER	TX	ONE HEALTH
19	23367	OTHER	TX	TEXAS TRUE CHOICE
20	23367	OTHER	TX	CIGNA
21	78170308	OTHER	TX	UNICARE

General Provider Information

NPI Number	:	1700883626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART JOEL NATHAN PH.D.

Provider Business Mailing Address
First Line	:	2450 FONDREN RD
Second Line	:	#312
City	:	HOUSTON
State	:	TX
Zip	:	77063-2323
Country	:	US
Telephone Number	:	713-789-7560
Fax Number	:	713-789-7351

Provider Business Practice Location Address
First Line	:	2450 FONDREN RD
Second Line	:	#312
City	:	HOUSTON
State	:	TX
Zip	:	77063-2318
Country	:	US
Telephone Number	:	713-789-7560
Fax Number	:	713-789-7351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/12/2010

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Directions to “ DR. STUART JOEL NATHAN PH.D.” Practice Location

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