Healthcare Provider Details

I. General information

NPI: 1609070374
Provider Name (Legal Business Name): SARAH TIGHE MCCUTCHEON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GREATLAND CLINICAL ASSOCIATES 1400 W BENSON BLVD STE 315
ANCHORAGE AK
99503
US

IV. Provider business mailing address

GREATLAND MENTAL HEALTH, LLC PO BOX 111810
ANCHORAGE AK
99511-1810
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-4009
  • Fax:
Mailing address:
  • Phone: 907-929-4009
  • Fax: 907-929-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number113469
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number113469
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: