Provider Demographics
NPI:1003883406
Name:STUTTS, MICHAEL L (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:STUTTS
Suffix:
Gender:M
Credentials:PHD
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8400
Mailing Address - Fax:757-446-8401
Practice Address - Street 1:825 FAIRFAX AVE STE 710
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5888
Practice Address - Fax:757-446-5918
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08010001340103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000496OtherVALUE OPTIONS
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL
VA007700245Medicaid
NC0367KOtherBC/BS
VAPAROtherAETNA
VA255618OtherMAGELLAN HEALTH SERVICES
VA343838OtherMANAGED HEALTH NETWORK
VAPAROtherMULTIPLAN
VAPAROtherCORVEL/CORCARE
VA215684OtherUNITED HEALTH CARE/MAMSI
VA-006OtherTRICARE/CHAMPUS
VA081903OtherANTHEM
VA88854OtherSENTARA/OPTIMA
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
VA007700245Medicaid
VA255618OtherMAGELLAN HEALTH SERVICES