Provider Demographics
NPI:1578528352
Name:SUTTON, SHIRLEY ANN (CPCI)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 W 6020 S
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5388
Mailing Address - Country:US
Mailing Address - Phone:801-972-2711
Mailing Address - Fax:801-972-2709
Practice Address - Street 1:1578 W 1700 S
Practice Address - Street 2:#200
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84104-3470
Practice Address - Country:US
Practice Address - Phone:801-972-2711
Practice Address - Fax:801-972-2709
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138811-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788007788049Medicaid