Provider Demographics
NPI:1801195896
Name:CUTHBERTSON, WILLIAM SR (NAT CERTIFIED COUNS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:CUTHBERTSON
Suffix:SR
Gender:M
Credentials:NAT CERTIFIED COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 E LAKE MEAD BLVD
Mailing Address - Street 2:APT#1152
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-1108
Mailing Address - Country:US
Mailing Address - Phone:609-221-7434
Mailing Address - Fax:
Practice Address - Street 1:1230 W OWENS AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2451
Practice Address - Country:US
Practice Address - Phone:702-636-5373
Practice Address - Fax:702-636-1393
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15637101YP2500X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional