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General NPI Number Information
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NPI Number | 1194202143
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Entity Type | Organization
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Legal Business Name | CUTSHALL COUNSELING, LLC
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 417 W 18TH ST STE 103
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City | EDMOND
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State | OK
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Zip | 73013-3692
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Country | US
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Telephone | 405-697-0582
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Fax |
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Provider Business Mailing Address
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Address Line | 2113 BRANDEN LN
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City | EDMOND
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State | OK
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Zip | 73003-2416
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Country | US
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Telephone | 405-697-0582
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE CUTSHALL
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Credential | LPC
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Telephone | 405-697-0582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6656
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License Number State | OK
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