Provider Demographics
NPI:1215575121
Name:STUTTS, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:STUTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W PIONEER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6146
Mailing Address - Country:US
Mailing Address - Phone:817-795-8278
Mailing Address - Fax:817-795-8279
Practice Address - Street 1:124 W PIONEER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6146
Practice Address - Country:US
Practice Address - Phone:817-795-8278
Practice Address - Fax:817-795-8279
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12665OtherLCDC LICENSE