Provider Demographics
NPI:1467501734
Name:SUTTON-GAMACHE, JOHN (PHD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:SUTTON-GAMACHE
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 1:5837 221ST PL SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8917
Mailing Address - Country:US
Mailing Address - Phone:425-391-0887
Mailing Address - Fax:425-391-7014
Practice Address - Street 1:5837 221ST PL SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8917
Practice Address - Country:US
Practice Address - Phone:425-391-0887
Practice Address - Fax:425-391-7014
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA02881103TC0700X
WAPY0001271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS02881Medicaid
AKR14808Medicare UPIN
AK150724Medicare PIN