Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 098631 | IA |
N | 101YM0800X | Mental Health Counselor | A9168 | NC |
NPI | 1003182692 |
---|---|
Provider Name | Molly Sutton |
First Address | Clive, IA 50325-8632 |
Second Address | West Des Moines, IA 50266-7714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 24/11/2020 |