Provider Demographics
NPI:1710858691
Name:PACKARD, NATHAN SCOTT
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:SCOTT
Last Name:PACKARD
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 1:315 EASTMAN
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48615-2508
Mailing Address - Country:US
Mailing Address - Phone:989-506-4590
Mailing Address - Fax:
Practice Address - Street 1:3600 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2301
Practice Address - Country:US
Practice Address - Phone:989-510-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist