Healthcare Provider Details

I. General information

NPI: 1902496268
Provider Name (Legal Business Name): MARION CUTRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12818 TESSON FERRY RD STE 103
SAINT LOUIS MO
63128-2945
US

IV. Provider business mailing address

12818 TESSON FERRY RD STE 103
SAINT LOUIS MO
63128-2945
US

V. Phone/Fax

Practice location:
  • Phone: 314-912-4655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2024007359
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: