Doctor Name: | MRS. JENNIFER LYNN MCCUTCHEON |
NPI Number: | 1194027433 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | 2010038676 |
Business Practice Address: | 4118 Miller St Bethany, MO - 644247169 |
Business Phone Number: | 6605379030 |
Business Fax Number: | |
Mailing Address: | 2205 Oakland Ave, BETHANY |
State: | MO |
Postal Code: | 644241348 |
Phone Number: | 6605379030 |
Fax Number: | |
NPI Enumeration Date: | 11/18/2010 |
NPI Last Update Date: | 11/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2010038676 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |