Healthcare Provider Details

I. General information

NPI: 1871656074
Provider Name (Legal Business Name): JONATHAN G CUDE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 KINWEST PKWY STE. # 107
IRVING TX
75063-3407
US

IV. Provider business mailing address

1075 KINWEST PKWY STE. # 107
IRVING TX
75063-3407
US

V. Phone/Fax

Practice location:
  • Phone: 972-910-8388
  • Fax: 972-910-8366
Mailing address:
  • Phone: 972-910-8388
  • Fax: 972-910-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9563
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: