Basic Information
| Provider Information | |||||||||
| NPI: | 1174768345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCUTCHEN | ||||||||
| FirstName: | WENDI | ||||||||
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| Credential: | LPC, CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 N COLLISTER DR | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837033732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083536147 | ||||||||
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| Practice Location | |||||||||
| Address1: | 660 E FRANKLIN RD | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836422910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083430441 | ||||||||
| FaxNumber: | 2083434993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2008 | ||||||||
| LastUpdateDate: | 11/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 10280000 | ID | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | LPC-4620 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.