Provider Demographics
NPI:1659418648
Name:BRUMFIELD, JONATHAN DAVID
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:BRUMFIELD
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:PO BOX 2578
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-2578
Mailing Address - Country:US
Mailing Address - Phone:870-793-8900
Mailing Address - Fax:870-793-8900
Practice Address - Street 1:1507 N PECAN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-2867
Practice Address - Country:US
Practice Address - Phone:870-793-8900
Practice Address - Fax:870-793-8900
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0910107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health