Provider Demographics
NPI:1912980426
Name:SUTTON, SHIRLEY (MED LPC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 BEACON CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-6433
Mailing Address - Country:US
Mailing Address - Phone:479-636-1112
Mailing Address - Fax:479-636-1112
Practice Address - Street 1:2303 BEACON CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-6433
Practice Address - Country:US
Practice Address - Phone:479-636-1112
Practice Address - Fax:479-636-1112
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9712029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health