Provider Demographics
NPI:1447509930
Name:CUTLAN, NATHAN GREGORY (LPC)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:GREGORY
Last Name:CUTLAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 GRAND AVE
Mailing Address - Street 2:UNIT #2
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2222
Mailing Address - Country:US
Mailing Address - Phone:612-735-8004
Mailing Address - Fax:
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:612-202-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional