Individual
JILL V MCNUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
7646 N TEUTONIA AVE, BROWN DEER, WI 53209-1736
(414) 797-2155
Mailing address
7651 N TEUTONIA AVE, BROWN DEER, WI 53209-1735
(414) 213-3979
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
3943-125
WI
101YM0800X
Mental Health Counselor
Primary
3943-125
WI
101YP2500X
Professional Counselor
3943-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
08/04/2010
Last updated
01/08/2020
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