Provider Demographics
NPI:1932203551
Name:CALDWELL, JOHN ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:STE 2B
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4017
Mailing Address - Country:US
Mailing Address - Phone:662-832-1658
Mailing Address - Fax:662-620-7106
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:STE 2B
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4017
Practice Address - Country:US
Practice Address - Phone:662-832-1658
Practice Address - Fax:662-620-7106
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05255791Medicaid
MS05255791Medicaid