Provider Demographics
NPI:1568201630
Name:CUTLER, HAVEN L
Entity type:Individual
Prefix:
First Name:HAVEN
Middle Name:L
Last Name:CUTLER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SW CLAY ST APT 6E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-6050
Mailing Address - Country:US
Mailing Address - Phone:502-507-5854
Mailing Address - Fax:
Practice Address - Street 1:1750 SW SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2533
Practice Address - Country:US
Practice Address - Phone:503-894-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health