Provider Demographics
NPI:1710159595
Name:DUTSON, DEVIN E (LCSW)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:E
Last Name:DUTSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2266
Mailing Address - Country:US
Mailing Address - Phone:307-254-3407
Mailing Address - Fax:
Practice Address - Street 1:1061 MORNING GLORY LN
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2266
Practice Address - Country:US
Practice Address - Phone:307-254-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-6291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical