Provider Demographics
NPI:1568556447
Name:DUTTON, JEFFERY DANIEL (PHD LPC MAC NCC)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:DANIEL
Last Name:DUTTON
Suffix:
Gender:M
Credentials:PHD LPC MAC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 KATHY LN SW
Mailing Address - Street 2:PO BX 2239
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1026
Mailing Address - Country:US
Mailing Address - Phone:256-306-4141
Mailing Address - Fax:306-301-3891
Practice Address - Street 1:1615 KATHY LN SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1026
Practice Address - Country:US
Practice Address - Phone:256-306-4141
Practice Address - Fax:306-301-3891
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-26338OtherBLUE CROSS