Provider Demographics
NPI:1437707767
Name:SUTTON, CJAY MITCHELL
Entity Type:Individual
Prefix:
First Name:CJAY
Middle Name:MITCHELL
Last Name:SUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 WILLIAMS FORK TRL APT 202
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3440
Mailing Address - Country:US
Mailing Address - Phone:978-604-2907
Mailing Address - Fax:
Practice Address - Street 1:1724 N GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1206
Practice Address - Country:US
Practice Address - Phone:303-237-6865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2021-05-25
Deactivation Date:2021-04-14
Deactivation Code:
Reactivation Date:2021-05-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health