Provider Demographics
NPI:1164439626
Name:SUTTON, JAMES EARL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EARL
Last Name:SUTTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 GARLAND
Mailing Address - Street 2:
Mailing Address - City:SYLVAN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48320
Mailing Address - Country:US
Mailing Address - Phone:248-682-4749
Mailing Address - Fax:
Practice Address - Street 1:1724 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1390
Practice Address - Country:US
Practice Address - Phone:248-408-8857
Practice Address - Fax:248-673-1145
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801010690101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0890881Medicare ID - Type Unspecified