Provider Demographics
NPI:1538192901
Name:TUTTY, STEVE R (PHD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:R
Last Name:TUTTY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9633 LEVIN RD NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8131
Mailing Address - Country:US
Mailing Address - Phone:206-499-7732
Mailing Address - Fax:360-930-8055
Practice Address - Street 1:9633 LEVIN RD NW
Practice Address - Street 2:SUITE 102
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8131
Practice Address - Country:US
Practice Address - Phone:206-499-7732
Practice Address - Fax:360-930-8055
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY-60112043103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8895905Medicare UPIN