Healthcare Provider Details

I. General information

NPI: 1356852834
Provider Name (Legal Business Name): BRANDON MCCUTCHEON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S MAIN ST
AKRON OH
44301-1664
US

IV. Provider business mailing address

1601 S MAIN ST
AKRON OH
44301-1664
US

V. Phone/Fax

Practice location:
  • Phone: 330-644-4095
  • Fax:
Mailing address:
  • Phone: 330-644-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.168817
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.000486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: