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General NPI Number Information
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NPI Number | 1679980031
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Entity Type | Individual
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Provider Name | ANDREW DUTTON LPC, LCDC
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Gender | Male
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 4316 BILGLADE RD
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City | FORT WORTH
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State | TX
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Zip | 76109-5317
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Country | US
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Telephone | 217-417-1059
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Fax |
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Provider Business Mailing Address
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Address Line | 4316 BILGLADE RD
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City | FORT WORTH
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State | TX
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Zip | 76109-5317
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Country | US
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Telephone | 217-417-1059
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 11953
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 72717
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License Number State | TX
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