Provider Demographics
NPI:1437969318
Name:GALVAN, NATHAN JAY
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JAY
Last Name:GALVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:JAY
Other - Last Name:TIEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 E PARMER LN APT 208
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-3538
Mailing Address - Country:US
Mailing Address - Phone:210-705-1026
Mailing Address - Fax:
Practice Address - Street 1:1200 E PARMER LN APT 208
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3538
Practice Address - Country:US
Practice Address - Phone:210-705-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health