Provider Demographics
NPI:1487746996
Name:MCCUTCHEON, JENI (PSYD, PLLC)
Entity type:Individual
Prefix:DR
First Name:JENI
Middle Name:
Last Name:MCCUTCHEON
Suffix:
Gender:F
Credentials:PSYD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7677
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0645
Mailing Address - Country:US
Mailing Address - Phone:602-368-2526
Mailing Address - Fax:602-368-2527
Practice Address - Street 1:4501 N 22ND ST STE 190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4625
Practice Address - Country:US
Practice Address - Phone:602-368-2526
Practice Address - Fax:602-368-2527
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-1799171OtherTAX ID NUMBER