Provider Demographics
NPI:1699241448
Name:CUTLIP, BRYSON (LLMSW)
Entity type:Individual
Prefix:
First Name:BRYSON
Middle Name:
Last Name:CUTLIP
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:DECKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48427-9629
Mailing Address - Country:US
Mailing Address - Phone:810-941-5101
Mailing Address - Fax:
Practice Address - Street 1:7676 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PORT SANILAC
Practice Address - State:MI
Practice Address - Zip Code:48469
Practice Address - Country:US
Practice Address - Phone:810-622-9610
Practice Address - Fax:810-622-7801
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011033081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
31954OtherNON-PROFIT