| Doctor Name: | DR. KENNETH MICHAEL NUTTER |
| NPI Number: | 1043383235 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD, LMHC |
| License Number: | MH 5058 |
| Business Practice Address: | 230 Tamiami Trl S Suite 3 Venice, FL - 342852453 |
| Business Phone Number: | 9413755222 |
| Business Fax Number: | 9414605109 |
| Mailing Address: | 516 Center Rd, VENICE |
| State: | FL |
| Postal Code: | 342854803 |
| Phone Number: | 9413755222 |
| Fax Number: | 9414605109 |
| NPI Enumeration Date: | 11/16/2006 |
| NPI Last Update Date: | 12/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | MH 5058 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |