MEDICARE: MATTHEW SUTTON LPC-S, LPE-I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P1007053	AR
2	103T00000X	Psychologist	13-38EI	AR

General Provider Information

NPI Number	:	1023296886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW SUTTON LPC-S, LPE-I

Provider Business Mailing Address
First Line	:	501 WESTWOOD DR
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2930
Country	:	US
Telephone Number	:	870-476-3058
Fax Number	:	870-455-6435

Provider Business Practice Location Address
First Line	:	210 E 7TH ST STE 6
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-4457
Country	:	US
Telephone Number	:	870-476-3058
Fax Number	:	870-455-6435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	09/28/2023

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