Provider Demographics
NPI:1053455048
Name:DUTTON, STEVEN SHAWN (LMHC;LMFT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:SHAWN
Last Name:DUTTON
Suffix:
Gender:M
Credentials:LMHC;LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 ALBRIGHT RD STE A
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3996
Mailing Address - Country:US
Mailing Address - Phone:765-450-9214
Mailing Address - Fax:765-792-4234
Practice Address - Street 1:2765 ALBRIGHT RD STE A
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3996
Practice Address - Country:US
Practice Address - Phone:765-450-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001962A101YM0800X
101YP2500X
IN35001758A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200929120AMedicaid