Provider Demographics
NPI:1629268297
Name:HATHCOAT, JOHN (BS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HATHCOAT
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E WILL ROGERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6352
Mailing Address - Country:US
Mailing Address - Phone:918-342-3334
Mailing Address - Fax:918-342-3367
Practice Address - Street 1:1010 E WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6352
Practice Address - Country:US
Practice Address - Phone:918-342-3334
Practice Address - Fax:918-342-3367
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK101YA0400XOtherTOXONAMY