Provider Demographics
NPI:1538665112
Name:DOUTHIT, JOHN JASON SR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JASON
Last Name:DOUTHIT
Suffix:SR
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 1:107 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2605
Mailing Address - Country:US
Mailing Address - Phone:816-695-0918
Mailing Address - Fax:
Practice Address - Street 1:107 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2605
Practice Address - Country:US
Practice Address - Phone:816-695-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician