Provider Demographics
NPI:1629533880
Name:ROBERTS, NATHAN DEAN (QBHP)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:DEAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9013
Mailing Address - Country:US
Mailing Address - Phone:269-389-9102
Mailing Address - Fax:
Practice Address - Street 1:126 E MAIN AVE # 1736
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1736
Practice Address - Country:US
Practice Address - Phone:616-900-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician