Provider Demographics
NPI:1558904490
Name:MCCUTCHEON, REGINALD (MFTA)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:MCCUTCHEON
Suffix:
Gender:M
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E REYNOLDS RD STE B6
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1279
Mailing Address - Country:US
Mailing Address - Phone:800-464-1958
Mailing Address - Fax:
Practice Address - Street 1:228 E REYNOLDS RD STE B6
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1279
Practice Address - Country:US
Practice Address - Phone:800-464-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260542106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist