Provider Demographics
NPI:1174332506
Name:NASH, BRYCE
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:NASH
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 1:3340 S LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4501
Mailing Address - Country:US
Mailing Address - Phone:765-661-9709
Mailing Address - Fax:765-573-6769
Practice Address - Street 1:3340 S LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4501
Practice Address - Country:US
Practice Address - Phone:765-661-9709
Practice Address - Fax:765-573-6769
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician