| Doctor Name: | JONATHAN G SEUBOLD |
| NPI Number: | 1073887238 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAC |
| License Number: | |
| Business Practice Address: | 815 Fort St Ste A Barling, AR - 729232164 |
| Business Phone Number: | 4794945700 |
| Business Fax Number: | 4794848142 |
| Mailing Address: | 3352 N Futrall Dr, FAYETTEVILLE |
| State: | AR |
| Postal Code: | 727034057 |
| Phone Number: | 4795211427 |
| Fax Number: | 4795216520 |
| NPI Enumeration Date: | 03/05/2012 |
| NPI Last Update Date: | 03/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |