Provider Demographics
NPI:1659336865
Name:TUTTY, DANIEL JOSEPH (PHD,LCSW,LADC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:TUTTY
Suffix:
Gender:M
Credentials:PHD,LCSW,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13228 IBSEN LN
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8315
Mailing Address - Country:US
Mailing Address - Phone:760-245-9203
Mailing Address - Fax:
Practice Address - Street 1:BLDG 170
Practice Address - Street 2:
Practice Address - City:FT.IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-3631
Practice Address - Fax:
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
NV01542-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV653-LOtherLICENSED ALCOHOL&DRUG COU
NV01542-COtherLICENSED CLINICAL SOCIAL