Healthcare Provider Details

I. General information

NPI: 1285789123
Provider Name (Legal Business Name): LARRY R SUTTON MAC, LAC, CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 W 8TH ST
PORT ANGELES WA
98362-5810
US

IV. Provider business mailing address

528 W 8TH ST
PORT ANGELES WA
98362-5810
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-9200
  • Fax: 360-457-9229
Mailing address:
  • Phone: 360-457-9200
  • Fax: 360-457-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00005626
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002243
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: