Provider Demographics
NPI:1043656747
Name:CAUTHEN, JOSEPH MATTHEW
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:CAUTHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 ANDREA DR
Mailing Address - Street 2:SUITE 4 BLD. E
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6726
Mailing Address - Country:US
Mailing Address - Phone:505-324-5855
Mailing Address - Fax:
Practice Address - Street 1:851 ANDREA DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6726
Practice Address - Country:US
Practice Address - Phone:505-324-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children