Provider Demographics
NPI:1851510903
Name:CAUTHEN, NELSON R (PHD CLINICAL PSYCHOL)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:R
Last Name:CAUTHEN
Suffix:
Gender:M
Credentials:PHD CLINICAL PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JONES LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:601-932-2493
Mailing Address - Fax:601-939-2243
Practice Address - Street 1:110 JONES LANE
Practice Address - Street 2:SUITE A
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-932-2493
Practice Address - Fax:601-939-2243
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS219103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017561Medicaid
R34666Medicare UPIN
MS680000025Medicare ID - Type Unspecified