Healthcare Provider Details

I. General information

NPI: 1790102119
Provider Name (Legal Business Name): JOEL R SUTTON PH.D., P.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 COMMERCE DR STE 101
PERRYSBURG OH
43551-5231
US

IV. Provider business mailing address

6950 INDEPENDENCE RD
DEFIANCE OH
43512-9030
US

V. Phone/Fax

Practice location:
  • Phone: 419-482-8382
  • Fax:
Mailing address:
  • Phone: 567-444-4825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0003037
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberE0003037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: