Provider Demographics
NPI:1003182692
Name:SUTTON, MOLLY (LMHC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LMHC, ATR-BC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:PETTIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13350 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8632
Mailing Address - Country:US
Mailing Address - Phone:319-936-5000
Mailing Address - Fax:
Practice Address - Street 1:12951 UNIVERSITY AVE STE 200F
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8297
Practice Address - Country:US
Practice Address - Phone:515-949-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098631101YM0800X
NCA9168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health