Healthcare Provider Details

I. General information

NPI: 1124484522
Provider Name (Legal Business Name): JULIE NETHERCUTT PSY.D. HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E CENTER STREET EXT
WARSAW IN
46582-3907
US

IV. Provider business mailing address

3201 E CENTER STREET EXT
WARSAW IN
46582-3907
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-1700
  • Fax: 574-267-0017
Mailing address:
  • Phone: 574-267-1700
  • Fax: 574-267-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040829A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: