Provider Demographics
NPI:1437897188
Name:MCNUTT, MARY SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 PINNACLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9619
Mailing Address - Country:US
Mailing Address - Phone:501-328-7957
Mailing Address - Fax:
Practice Address - Street 1:2560 PINNACLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-9619
Practice Address - Country:US
Practice Address - Phone:501-328-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1664-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical