Provider Demographics
NPI:1225285679
Name:ROTH, NATHAN PAUL (PHD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:PAUL
Last Name:ROTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0865
Mailing Address - Country:US
Mailing Address - Phone:828-399-1399
Mailing Address - Fax:828-475-0400
Practice Address - Street 1:3770 SKYLAND DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-8360
Practice Address - Country:US
Practice Address - Phone:828-399-1399
Practice Address - Fax:828-475-0400
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4079103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent