Provider Demographics
NPI:1902357965
Name:NATASHA J CUTLER, LCSW
Entity Type:Organization
Organization Name:NATASHA J CUTLER, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-221-1161
Mailing Address - Street 1:1070 HILINE RD STE 335
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2955
Mailing Address - Country:US
Mailing Address - Phone:208-681-9178
Mailing Address - Fax:208-575-0474
Practice Address - Street 1:1070 HILINE RD STE 335
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2955
Practice Address - Country:US
Practice Address - Phone:208-681-9178
Practice Address - Fax:208-575-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 346761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1720317589OtherINDIVIDUAL NPI