Provider Demographics
NPI:1730319179
Name:MCCUTCHEON, P.C.
Entity Type:Organization
Organization Name:MCCUTCHEON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHEON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-575-6224
Mailing Address - Street 1:7115 VIRGINIA RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3110
Mailing Address - Country:US
Mailing Address - Phone:815-575-6224
Mailing Address - Fax:815-356-8975
Practice Address - Street 1:7115 VIRGINIA RD STE 110
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3110
Practice Address - Country:US
Practice Address - Phone:815-575-6224
Practice Address - Fax:815-356-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490115691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty