Healthcare Provider Details

I. General information

NPI: 1336237635
Provider Name (Legal Business Name): JOHNATHAN DAVID STEELE MS, MMS, LPC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 ARKANSAS BLVD
TEXARKANA AR
71854-2536
US

IV. Provider business mailing address

2904 ARKANSAS BLVD
TEXARKANA AR
71854-2536
US

V. Phone/Fax

Practice location:
  • Phone: 870-773-4655
  • Fax: 870-772-4650
Mailing address:
  • Phone: 870-773-4655
  • Fax: 870-772-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number57816
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-296
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA050593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: