Healthcare Provider Details

I. General information

NPI: 1295039600
Provider Name (Legal Business Name): MR. JONATHAN PAUL CAUTHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BROADWAY
POTEAU OK
74953
US

IV. Provider business mailing address

PO BOX 354 40938 OLD US HIGHWAY 59
HOWE OK
74940
US

V. Phone/Fax

Practice location:
  • Phone: 918-839-7797
  • Fax:
Mailing address:
  • Phone: 918-839-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberMC-04-19
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: