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NPI Code Detail

MEDICARE: MS. KELSEE LANE MCCUTCHEN MS, LPC

MEDICARE: MS. KELSEE LANE MCCUTCHEN MS, LPC
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
1101Y00000XCounselor
2101YA0400XAddiction (Substance Use Disorder) Counselor6214OK
3101YM0800XMental Health Counselor06214OK
4171M00000XCase Manager/Care Coordinator
5390200000XStudent in an Organized Health Care Education/Training Program
6101YM0800XMental Health Counselor6214OK

General Provider Information

NPI Number : 1518208040
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELSEE LANE MCCUTCHEN MS, LPC
Provider Business Mailing Address
First Line : 907 W CADDO ST
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-4201
Country : US
Telephone Number : 918-308-5511
Fax Number : 918-205-2701
Provider Business Practice Location Address
First Line : 907 W CADDO ST
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-4201
Country : US
Telephone Number : 918-308-5511
Fax Number : 918-205-2701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2013
Last Update Date : 08/12/2021

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