Provider Demographics
NPI:1255313177
Name:CLUTTERBUCK, OWEN LEE (EDD, MSW)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:LEE
Last Name:CLUTTERBUCK
Suffix:
Gender:M
Credentials:EDD, MSW
Other - Prefix:DR
Other - First Name:OWEN
Other - Middle Name:LEE
Other - Last Name:CLUTTERBUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, MSW
Mailing Address - Street 1:8595 BEECHMONT AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-4740
Mailing Address - Country:US
Mailing Address - Phone:513-474-9000
Mailing Address - Fax:859-635-2873
Practice Address - Street 1:8595 BEECHMONT AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4740
Practice Address - Country:US
Practice Address - Phone:513-474-9000
Practice Address - Fax:859-635-2873
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00000131-OH101YM0800X, 106H00000X
OHI-00000-131-OH1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist