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General NPI Number Information
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NPI Number | 1003092479
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Entity Type | Organization
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Legal Business Name | JONATHAN D CARGILL, PHD, INC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 23 E 9TH ST SUITE 311
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City | SHAWNEE
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State | OK
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Zip | 74801-6943
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Country | US
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Telephone | 405-275-6701
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Fax | 405-598-3668
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Provider Business Mailing Address
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Address Line | PO BOX 114
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City | TECUMSEH
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State | OK
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Zip | 74873-0114
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Country | US
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Telephone | 405-598-3668
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Fax | 405-598-0338
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN DALE CARGILL
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Credential | PHD
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Telephone | 405-598-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 300
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License Number State | OK
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