Healthcare Provider Details

I. General information

NPI: 1225213309
Provider Name (Legal Business Name): JOANNA LYNN CUTLIP M.ED., PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CLEVELAND AVE NW SUITE 300
CANTON OH
44702-1700
US

IV. Provider business mailing address

510 S MAIN ST
ORRVILLE OH
44667-2202
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-7066
  • Fax: 330-454-9427
Mailing address:
  • Phone: 330-682-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0002277
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: