Provider Demographics
NPI:1265730196
Name:TUTTLE, DEBRA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:51559-3058
Mailing Address - Country:US
Mailing Address - Phone:402-332-8473
Mailing Address - Fax:402-916-9654
Practice Address - Street 1:11252 S 200TH ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4541
Practice Address - Country:US
Practice Address - Phone:402-659-6507
Practice Address - Fax:402-916-9654
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3825101YM0800X
NE13841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE3825OtherNEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES LMHP
NE1384OtherNEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES LMSW