Provider Demographics
NPI:1689366064
Name:POWERS, NATHANIEL WALDEN (LMFT)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:WALDEN
Last Name:POWERS
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E PALMER MILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-1827
Mailing Address - Country:US
Mailing Address - Phone:386-283-1883
Mailing Address - Fax:850-807-5293
Practice Address - Street 1:515 E PALMER MILL RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1827
Practice Address - Country:US
Practice Address - Phone:386-283-1883
Practice Address - Fax:850-807-5293
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist