Provider Demographics
NPI:1013677681
Name:TUTT, ALISON KAY (LAC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:KAY
Last Name:TUTT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:KAY
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 HOGAN LN APT 2001
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7864
Mailing Address - Country:US
Mailing Address - Phone:479-747-5290
Mailing Address - Fax:
Practice Address - Street 1:1601 HOGAN LN APT 2001
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7864
Practice Address - Country:US
Practice Address - Phone:479-747-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health