Basic Information
| Provider Information | |||||||||
| NPI: | 1649568916 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCUTCHEON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | RUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22742 GODDARD RD | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481804126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133191259 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13101 ALLEN RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347857700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2011 | ||||||||
| LastUpdateDate: | 07/20/2011 | ||||||||
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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 | 104100000X | 6803085776 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.