MEDICARE: MR. JEFFERY DANIEL DUTTON PHD. LPC MAC NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2290	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-26338	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1568556447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFERY DANIEL DUTTON PHD. LPC MAC NCC

Provider Business Mailing Address
First Line	:	1615 KATHY LN SW
Second Line	:	PO BX 2239
City	:	DECATUR
State	:	AL
Zip	:	35603-1026
Country	:	US
Telephone Number	:	256-306-4141
Fax Number	:	306-301-3891

Provider Business Practice Location Address
First Line	:	1615 KATHY LN SW
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-1026
Country	:	US
Telephone Number	:	256-306-4141
Fax Number	:	306-301-3891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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