Provider Demographics
NPI:1528093234
Name:CAWTHORN, RICK ALLAN
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:ALLAN
Last Name:CAWTHORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:ALLAN
Other - Last Name:CAWTHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:2908 BAY ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3613
Mailing Address - Country:US
Mailing Address - Phone:530-355-7778
Mailing Address - Fax:
Practice Address - Street 1:2908 BAY ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3613
Practice Address - Country:US
Practice Address - Phone:530-355-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25386106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist