Provider Demographics
NPI:1568961027
Name:MCNUTT, STEPHEN DANIEL
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DANIEL
Last Name:MCNUTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N BROADWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2624
Mailing Address - Country:US
Mailing Address - Phone:714-245-6881
Mailing Address - Fax:
Practice Address - Street 1:2100 N BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2624
Practice Address - Country:US
Practice Address - Phone:714-245-6881
Practice Address - Fax:714-245-6881
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health