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General NPI Number Information
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NPI Number | 1619521945
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Entity Type | Individual
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Provider Name | BETH MARIE MUTTON LCPC,CADC,SAP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 7294 ARGUS DR
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City | ROCKFORD
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State | IL
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Zip | 61107-5837
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Country | US
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Telephone | 815-391-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 1549 RED OAK LN
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City | ROCKFORD
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State | IL
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Zip | 61107-2711
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Country | US
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Telephone | 815-670-6056
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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 | 180015969
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License Number State | IL
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