Provider Demographics
NPI:1205442217
Name:DUTTON, DAVID LEE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:DUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 GUERNEVILLE RD.
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-575-0979
Mailing Address - Fax:707-546-3308
Practice Address - Street 1:201 S. E STREET
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-573-6960
Practice Address - Fax:707-573-6961
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health