Provider Demographics
NPI:1114560596
Name:DUTTON, HALEIGH R (BCBA)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:R
Last Name:DUTTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 KIRKPATRICK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32409-2127
Mailing Address - Country:US
Mailing Address - Phone:850-890-3721
Mailing Address - Fax:
Practice Address - Street 1:80 COLLEGE BLVD E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1343
Practice Address - Country:US
Practice Address - Phone:850-279-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-22-59252103K00000X
FLRBT-19-95999106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician