Provider Demographics
NPI:1124379110
Name:MCCUTCHEON, KIMBERLY (MHR, LPC, CCTP-II)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCCUTCHEON
Suffix:
Gender:F
Credentials:MHR, LPC, CCTP-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17520 THUNDERBIRD HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NEWALLA
Mailing Address - State:OK
Mailing Address - Zip Code:74857-9438
Mailing Address - Country:US
Mailing Address - Phone:405-481-3022
Mailing Address - Fax:
Practice Address - Street 1:17520 THUNDERBIRD HILLS RD
Practice Address - Street 2:
Practice Address - City:NEWALLA
Practice Address - State:OK
Practice Address - Zip Code:74857-9438
Practice Address - Country:US
Practice Address - Phone:405-481-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC05726101YP2500X, 101YA0400X, 101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor