| Organization Name: | JONATHAN D CARGILL, PHD, INC |
| NPI Number: | 1003092479 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JONATHAN DALE CARGILL (PRESIDENT) |
| Mailing Address: | 23 E 9th St Suite 311 Shawnee |
| State: | OK US |
| Postal Code: | 748016943 |
| Phone Number: | 4052756701 |
| Fax Number: | 4055983668 |
| NPI Enumeration Date: | 01/16/2008 |
| NPI Last Update Date: | 01/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |