1841344256 NPI number — DR. LARISA K HUTCHINS PSY.D.

Table of content: DR. LARISA K HUTCHINS PSY.D. (NPI 1841344256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841344256 NPI number — DR. LARISA K HUTCHINS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTCHINS
Provider First Name:
LARISA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841344256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1563 W POND DR
Provider Second Line Business Mailing Address:
UNIT 34
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48864-2386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-347-2583
Provider Business Mailing Address Fax Number:
517-347-7892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4660 MARSH RD
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-420-2788
Provider Business Practice Location Address Fax Number:
517-347-7892
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6301008832 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com