1396333977 NPI number — KALA JUNE HUTCHINSON LPC, CAADC

Table of content: KALA JUNE HUTCHINSON LPC, CAADC (NPI 1396333977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396333977 NPI number — KALA JUNE HUTCHINSON LPC, CAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTCHINSON
Provider First Name:
KALA
Provider Middle Name:
JUNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, CAADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
KALA
Provider Other Middle Name:
JUNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396333977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1916 TREMBLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIAN RIVER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49749-9545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1916 TREMBLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN RIVER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49749-9545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-268-9583
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2021

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: 101YA0400X , with the licence number:  C-04915 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 6401222710 , 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 © 2007-2025 www.npivalidator.com