Provider Demographics
NPI:1215119201
Name:SUTTON, THEODORE COOPER (FSWC I/COUNSELOR)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:COOPER
Last Name:SUTTON
Suffix:
Gender:M
Credentials:FSWC I/COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRISTOL BAY AREA HEALTH CORPORATION
Mailing Address - Street 2:TOGIAK BEHAVIORAL HEALTH PROGRAM, P.O. BOX 409
Mailing Address - City:TOGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99678-0409
Mailing Address - Country:US
Mailing Address - Phone:907-493-5637
Mailing Address - Fax:907-493-5184
Practice Address - Street 1:MAIN STREET BRISTOL BAY AREA HEALTH CORPORATION
Practice Address - Street 2:TOGIAK BEHAVIORAL HEALTH PROGRAM, FAMILY RESOURCE BLD.
Practice Address - City:TOGIAK
Practice Address - State:AK
Practice Address - Zip Code:99678-0409
Practice Address - Country:US
Practice Address - Phone:907-493-5637
Practice Address - Fax:907-493-5184
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKRHS CERTIFICATION101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)