Provider Demographics
NPI:1245411933
Name:SUTTON, GREGORY LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LEE
Last Name:SUTTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5734
Mailing Address - Country:US
Mailing Address - Phone:208-559-5666
Mailing Address - Fax:
Practice Address - Street 1:202 N 9TH ST
Practice Address - Street 2:303C
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5734
Practice Address - Country:US
Practice Address - Phone:208-559-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional