Kimberly McCutcheon, MHR, LPC, CCTP-II
Individual provider Active NPI Professional Counselor · Newalla, OK
NPI 1124379110 · NPPES record last updated Sep 13, 2024
Key facts
- NPI
- 1124379110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC05726 (OK)
- Practice address
- 17520 Thunderbird Hills Rd
Newalla, OK 74857-9438 - Phone
- (405) 481-3022
- NPI assigned
- Oct 1, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241231000879 | OK | Practitioner - Mental Health Counselor | 1658808779 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Better Life Therapy LLC | Addiction (Substance Use Disorder) | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC05726 | OK | Yes |
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | LPC05726 | OK | |
| Mental Health Counselor | 101YM0800X | LPC05726 | OK | |
| Counselor | 101Y00000X |
Addresses
Primary practice location
17520 Thunderbird Hills Rd
Newalla, OK 74857-9438
Mailing address
17520 Thunderbird Hills Rd
Newalla, OK 74857-9438
Phone (405) 481-3022
Other providers in Newalla, OK
- Nicholas Hughes
- Tristan Daniel Hughes
- Tamra Realta James
- Gena Jenkins
- Low Vision Strategies, LLC
- Katherine McElwee
- Kimberly Anne Nelson
- Daniel Alan O'Connor
- Ok Peds Pediatric Therapy Services
- Lynndee Parsons
All providers in Newalla, OK · Professional Counselor in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.