Provider Demographics
NPI:1477836559
Name:TUTTLE, JOHN LAWRENCE (MA, MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:MA, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8046 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7766
Mailing Address - Country:US
Mailing Address - Phone:616-826-3115
Mailing Address - Fax:
Practice Address - Street 1:8046 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-7766
Practice Address - Country:US
Practice Address - Phone:616-826-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012653101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health