Provider Demographics
NPI:1982465308
Name:JUTILA, ERIC (LLMSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:JUTILA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:ERIE
Other - Middle Name:
Other - Last Name:JUTILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23231 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1361
Mailing Address - Country:US
Mailing Address - Phone:517-672-6641
Mailing Address - Fax:
Practice Address - Street 1:1126 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2214
Practice Address - Country:US
Practice Address - Phone:248-581-8777
Practice Address - Fax:888-975-9374
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511176281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical