Provider Demographics
NPI:1275910507
Name:CUTSHALL, JESSICA (MA, LPC/CR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CUTSHALL
Suffix:
Gender:F
Credentials:MA, LPC/CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 FISHINGER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221
Mailing Address - Country:US
Mailing Address - Phone:614-822-7819
Mailing Address - Fax:614-372-5590
Practice Address - Street 1:1080 FISHINGER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221
Practice Address - Country:US
Practice Address - Phone:614-822-7819
Practice Address - Fax:614-372-5590
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional