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General NPI Number Information
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NPI Number | 1285735357
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Entity Type | Individual
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Provider Name | JACK A DUTTON MA, LPC, LBSW
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 217 E SANILAC RD
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City | SANDUSKY
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State | MI
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Zip | 48471-1383
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Country | US
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Telephone | 810-583-0393
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Fax |
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Provider Business Mailing Address
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Address Line | 6780 UPPER RD
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City | MARLETTE
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State | MI
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Zip | 48453-9560
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Country | US
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Telephone | 989-635-7852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401003332
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802035127
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License Number State | MI
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