MEDICARE: CAMILLE CUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	13028633-3904	UT

General Provider Information

NPI Number	:	1336974807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE CUTLER

Provider Business Mailing Address
First Line	:	1445 WILD ROSE WAY
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84404-6172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 N 2000 W STE 7
Second Line	:
City	:	FARR WEST
State	:	UT
Zip	:	84404-8060
Country	:	US
Telephone Number	:	800-866-4657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/04/2024

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Directions to “ CAMILLE CUTLER ” Practice Location

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