Provider Demographics
NPI:1487252326
Name:NAGEL, MICAH BLAINE
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:BLAINE
Last Name:NAGEL
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 1:143 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4115
Mailing Address - Country:US
Mailing Address - Phone:724-944-2018
Mailing Address - Fax:
Practice Address - Street 1:2644 BANKSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2812
Practice Address - Country:US
Practice Address - Phone:412-343-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional