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General NPI Number Information
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NPI Number | 1295039600
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Entity Type | Individual
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Provider Name | MR. JONATHAN PAUL CAUTHEN
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Gender | Male
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 900 BROADWAY
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City | POTEAU
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State | OK
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Zip | 74953
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Country | US
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Telephone | 918-839-7797
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 354 40938 OLD US HIGHWAY 59
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City | HOWE
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State | OK
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Zip | 74940
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Country | US
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Telephone | 918-839-7797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | MC-04-19
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License Number State | OK
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