Provider Information for 1003586611
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Ms. MELISSA CAUTHEN LCSW
Sex: Female
NPI: 1003586611
Last Updated: 2024-10-30
Certification Date: 2024-10-30
Certification Date: 2024-10-30
Details
Name | Value | ||||||||||||||||
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NPI | 1003586611 | ||||||||||||||||
Enumeration Date | 2021-09-15 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 1016 S EMERALD LN CARBONDALE, IL 62901-2434 United States Phone: 618-559-6346 | Fax: | ||||||||||||||||
Primary Practice Address | 1016 S EMERALD LN CARBONDALE, IL 62901-2434 United States Phone: 618-559-6346 | Fax: | ||||||||||||||||
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