Provider Demographics
NPI:1225875198
Name:NUTTING, DAWN MARIE (CADC, CRCS)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:NUTTING
Suffix:
Gender:F
Credentials:CADC, CRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5667
Mailing Address - Country:US
Mailing Address - Phone:208-280-9695
Mailing Address - Fax:
Practice Address - Street 1:562 SHOUP AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5029
Practice Address - Country:US
Practice Address - Phone:208-280-9695
Practice Address - Fax:208-734-3435
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IDACD-5046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist