Provider Demographics
NPI:1205174711
Name:CLUTTER, DONALD (PT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CLUTTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 MESA VIEW DR
Mailing Address - Street 2:# 240
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5548
Mailing Address - Country:US
Mailing Address - Phone:760-694-7409
Mailing Address - Fax:
Practice Address - Street 1:212 CARMEN LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7769
Practice Address - Country:US
Practice Address - Phone:805-205-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15664374700000X, 167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No374700000XNursing Service Related ProvidersTechnician