Provider Demographics
NPI:1417532904
Name:SUTTON, KRISTINA (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VIKING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-9774
Mailing Address - Country:US
Mailing Address - Phone:517-242-3228
Mailing Address - Fax:
Practice Address - Street 1:400 VIKING VIEW DR
Practice Address - Street 2:
Practice Address - City:POTTERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48876-9774
Practice Address - Country:US
Practice Address - Phone:517-242-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018448101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor