Healthcare Provider Details

I. General information

NPI: 1558438465
Provider Name (Legal Business Name): CHRYSTYL D TUTT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 PEACHTREE ST NW SUITE 530
ATLANTA GA
30309-2434
US

IV. Provider business mailing address

231 ANNIVERSARY LN
ACWORTH GA
30102-2028
US

V. Phone/Fax

Practice location:
  • Phone: 678-521-1735
  • Fax:
Mailing address:
  • Phone: 678-521-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003022
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY003022
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: