Provider Demographics
NPI:1568427961
Name:SUTTON, PAMELA TAYLOR (LCPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:TAYLOR
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 W BRIGHTON AVE
Mailing Address - Street 2:JOHN R DAY & ASSOCIATES
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2938
Mailing Address - Country:US
Mailing Address - Phone:309-692-7755
Mailing Address - Fax:309-692-2262
Practice Address - Street 1:3716 W BRIGHTON AVE
Practice Address - Street 2:JOHN R DAY & ASSOCIATES
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2938
Practice Address - Country:US
Practice Address - Phone:309-692-7755
Practice Address - Fax:309-692-2262
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional