Provider Demographics
NPI:1174768345
Name:MCCUTCHEN ADAMS, WENDI (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:MCCUTCHEN ADAMS
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23423 OLD HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607
Mailing Address - Country:US
Mailing Address - Phone:208-353-6147
Mailing Address - Fax:866-722-6557
Practice Address - Street 1:23423 OLD HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607
Practice Address - Country:US
Practice Address - Phone:208-353-6147
Practice Address - Fax:866-722-6557
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5830101YP2500X
ID10280000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)