Basic Information
| Provider Information | |||||||||
| NPI: | 1356760094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCUTCHEON | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | MITCHEL | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 THIRTY ACRES | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442363327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308194505 | ||||||||
| FaxNumber: | 5132453672 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443103110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308194505 | ||||||||
| FaxNumber: | 5135580877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2014 | ||||||||
| LastUpdateDate: | 09/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35.133023 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 390200000X | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.