Jennifer Jo Dutton
Individual provider Active NPI Mental Health Counselor · Crescent City, CA
NPI 1801429436 · NPPES record last updated Feb 21, 2020
Key facts
- NPI
- 1801429436
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 89987 (CA)
- Practice address
- 455 K St
Crescent City, CA 95531-4107 - Phone
- (707) 464-7224
- Fax
- (707) 465-4272
- NPI assigned
- Feb 21, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Open Door Community Health Centers
Practice addresses (Care Compare)
550 E Washington Blvd
Crescent City, CA 95531-8160
Phone (707) 465-6925
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260312003106 | CA | Practitioner - Clinical Social Worker | 5698258192 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89987 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 89987 | CA | Yes |
Addresses
Primary practice location
455 K St
Crescent City, CA 95531-4107
Mailing address
455 K St
Crescent City, CA 95531-4107
Phone (707) 464-7224
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101YM0800X | Medicaid | CA |
Other providers in Crescent City, CA
- Scott Drinnon
- Anne Marie Duncan
- Kelly Dunn
- Lucie Dunn
- Maria Stanton Durazo
- Kristi Ann Edgar
- Shaun Rebecca Edwards
- Nabil Elkhoury
- Christy Eileen Emrich
- Enderts Drug Store Inc
All providers in Crescent City, CA · Mental Health Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.