MEDICARE: NATHAN TALLMADGE CALDWELL

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891953550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN TALLMADGE CALDWELL

Provider Business Mailing Address
First Line	:	1440 E FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3502
Country	:	US
Telephone Number	:	719-667-7043
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 E FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3502
Country	:	US
Telephone Number	:	719-667-7043
Fax Number	:

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

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	04/05/2017

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