Provider Demographics
NPI:1023872785
Name:MEESEY, NATHANAEL BLAKE
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:BLAKE
Last Name:MEESEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 RIVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4634
Mailing Address - Country:US
Mailing Address - Phone:417-812-3396
Mailing Address - Fax:
Practice Address - Street 1:4825 RIVERTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4634
Practice Address - Country:US
Practice Address - Phone:417-812-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst