Provider Demographics
NPI:1376561555
Name:SUTTON, PHILIP D (PHD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:D
Last Name:SUTTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1781
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-1781
Mailing Address - Country:US
Mailing Address - Phone:303-258-7582
Mailing Address - Fax:303-444-7371
Practice Address - Street 1:595 CANYON BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5029
Practice Address - Country:US
Practice Address - Phone:303-258-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO817103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist