Provider Demographics
NPI:1548399017
Name:SUTTON, CONNIE LOUISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LOUISE
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 1:2507 MAIN AVE N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-9297
Mailing Address - Country:US
Mailing Address - Phone:503-812-9675
Mailing Address - Fax:
Practice Address - Street 1:2507 MAIN AVE N
Practice Address - Street 2:SUITE B
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-9297
Practice Address - Country:US
Practice Address - Phone:503-812-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2624101YP2500X
101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health