Provider Demographics
NPI:1689911307
Name:DUTTON, JOHN (LIMHP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DUTTON
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 4TH AVE
Mailing Address - Street 2:SUITE 32
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2878
Mailing Address - Country:US
Mailing Address - Phone:308-234-6029
Mailing Address - Fax:308-237-4792
Practice Address - Street 1:4111 4TH AVE
Practice Address - Street 2:SUITE 32
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2878
Practice Address - Country:US
Practice Address - Phone:308-234-6029
Practice Address - Fax:308-237-4792
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NE9849101YM0800X
NE2173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health