Healthcare Provider Details

I. General information

NPI: 1043182504
Provider Name (Legal Business Name): GUIDED MOMENTUM THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4334 W CENTRAL AVE STE 202
TOLEDO OH
43615-1679
US

IV. Provider business mailing address

4334 W CENTRAL AVE STE 202
TOLEDO OH
43615-1679
US

V. Phone/Fax

Practice location:
  • Phone: 419-482-8551
  • Fax:
Mailing address:
  • Phone: 419-482-8551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN ALEXANDER MCCUTCHEON
Title or Position: OWNER
Credential: LISW-S
Phone: 567-395-1453