Provider Demographics
NPI:1255507612
Name:DUTTON, GLENN (CPCI)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:DUTTON
Suffix:
Gender:M
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5691 S REDWOOD RD UNIT 16
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5485
Mailing Address - Country:US
Mailing Address - Phone:801-265-3895
Mailing Address - Fax:801-263-1265
Practice Address - Street 1:5691 S REDWOOD RD UNIT 16
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5485
Practice Address - Country:US
Practice Address - Phone:801-265-3895
Practice Address - Fax:801-263-1265
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274192-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional