Healthcare Provider Details

I. General information

NPI: 1043734841
Provider Name (Legal Business Name): DAVID L NUTTER MA/MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 N ATLANTIC AVE STE 627
COCOA BEACH FL
32931-3274
US

IV. Provider business mailing address

1980 N ATLANTIC AVE STE 627
COCOA BEACH FL
32931-3274
US

V. Phone/Fax

Practice location:
  • Phone: 435-225-6566
  • Fax:
Mailing address:
  • Phone: 435-225-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: