Provider Demographics
NPI:1295764389
Name:CANUTT, JOY (CADCII)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:CANUTT
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1110
Mailing Address - Country:US
Mailing Address - Phone:503-621-1069
Mailing Address - Fax:503-621-0200
Practice Address - Street 1:1776 SW MADISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1715
Practice Address - Country:US
Practice Address - Phone:503-228-8612
Practice Address - Fax:503-227-2495
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR03-07-49101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126370Medicaid