Provider Demographics
NPI:1306115977
Name:SUTTON, INGRID (LCSW)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N MILLER RD
Mailing Address - Street 2:140
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3619
Mailing Address - Country:US
Mailing Address - Phone:602-297-5217
Mailing Address - Fax:602-297-5216
Practice Address - Street 1:4300 N MILLER RD
Practice Address - Street 2:140
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3619
Practice Address - Country:US
Practice Address - Phone:602-297-5217
Practice Address - Fax:602-297-5216
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 25561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical