Provider Demographics
NPI:1194588152
Name:DUTMER, ZACHARY (LLMSW)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:DUTMER
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3434
Mailing Address - Country:US
Mailing Address - Phone:231-346-5238
Mailing Address - Fax:231-922-4884
Practice Address - Street 1:1010 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3434
Practice Address - Country:US
Practice Address - Phone:231-346-5238
Practice Address - Fax:231-922-4884
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511172871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical