Provider Demographics
NPI:1477757474
Name:NUTTING,, ROBERT LEWIS (MSW, LCSW, LMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:NUTTING,
Suffix:
Gender:M
Credentials:MSW, LCSW, LMT
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 302
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:OR
Mailing Address - Zip Code:97533-0302
Mailing Address - Country:US
Mailing Address - Phone:541-660-5714
Mailing Address - Fax:
Practice Address - Street 1:D'ANJOU BUILDING (NOT A MAILIING ADDRESS)
Practice Address - Street 2:328 SOUTH CENTRAL AVENUE
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-660-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13466225700000X
ORL51271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist