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General NPI Number Information
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NPI Number | 1194027433
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Entity Type | Individual
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Provider Name | JENNIFER LYNN MCCUTCHEON LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 4118 MILLER ST
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City | BETHANY
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State | MO
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Zip | 64424-7169
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Country | US
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Telephone | 660-537-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 OAKLAND AVE
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City | BETHANY
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State | MO
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Zip | 64424-1348
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Country | US
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Telephone | 660-537-9030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2010038676
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License Number State | MO
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