Provider Demographics
NPI:1821588021
Name:TUTTLE, AMELIA E (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:E
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 BLUE RIDGE AVE NE APT 5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4416
Mailing Address - Country:US
Mailing Address - Phone:703-402-4063
Mailing Address - Fax:
Practice Address - Street 1:23 LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3172
Practice Address - Country:US
Practice Address - Phone:678-242-9472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist