Healthcare Provider Details

I. General information

NPI: 1982015418
Provider Name (Legal Business Name): THERESA MARIE NUTTEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E MICHIGAN AVE SUITE 17
KALAMAZOO MI
49007-3800
US

IV. Provider business mailing address

350 E MICHIGAN AVE STE 17
KALAMAZOO MI
49007-3848
US

V. Phone/Fax

Practice location:
  • Phone: 269-359-1873
  • Fax:
Mailing address:
  • Phone: 269-359-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20043830A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: