Provider Demographics
NPI:1871656074
Name:CUDE, JONATHAN G (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:G
Last Name:CUDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1075 KINWEST PKWY
Mailing Address - Street 2:STE. # 107
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3407
Mailing Address - Country:US
Mailing Address - Phone:972-910-8388
Mailing Address - Fax:972-910-8366
Practice Address - Street 1:1075 KINWEST PKWY
Practice Address - Street 2:STE. # 107
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3407
Practice Address - Country:US
Practice Address - Phone:972-910-8388
Practice Address - Fax:972-910-8366
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9563101YP2500X
TX1254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist