Provider Demographics
NPI:1306133327
Name:CADDEL, JOHN KURT (CI)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KURT
Last Name:CADDEL
Suffix:
Gender:M
Credentials:CI
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2700 YONKERS ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-1826
Mailing Address - Country:US
Mailing Address - Phone:806-293-2636
Mailing Address - Fax:806-296-5804
Practice Address - Street 1:2700 YONKERS ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1826
Practice Address - Country:US
Practice Address - Phone:806-293-2636
Practice Address - Fax:806-296-5804
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)