Healthcare Provider Details

I. General information

NPI: 1518208040
Provider Name (Legal Business Name): KELSEE LANE MCCUTCHEN MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEE LANE REEVES MS, LPC

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W CADDO ST
CLEVELAND OK
74020-4201
US

IV. Provider business mailing address

907 W CADDO ST
CLEVELAND OK
74020-4201
US

V. Phone/Fax

Practice location:
  • Phone: 918-308-5511
  • Fax: 918-205-2701
Mailing address:
  • Phone: 918-308-5511
  • Fax: 918-205-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6214
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number06214
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6214
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: