Provider Demographics
NPI:1073887238
Name:SEUBOLD, JONATHAN G (LAC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:G
Last Name:SEUBOLD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 N FUTRALL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4057
Mailing Address - Country:US
Mailing Address - Phone:479-521-1427
Mailing Address - Fax:479-521-6520
Practice Address - Street 1:815 FORT ST
Practice Address - Street 2:STE A
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2164
Practice Address - Country:US
Practice Address - Phone:479-494-5700
Practice Address - Fax:479-484-8142
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health