MEDICARE: MRS. HANNELORE HUTTON LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC21520	CA

General Provider Information

NPI Number	:	1881926301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNELORE HUTTON LMFT

Provider Business Mailing Address
First Line	:	8618 S SEPULVEDA BLVD
Second Line	:	SUITE 330
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4005
Country	:	US
Telephone Number	:	310-216-7109
Fax Number	:	310-645-0322

Provider Business Practice Location Address
First Line	:	8618 S SEPULVEDA BLVD
Second Line	:	SUITE 330
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4005
Country	:	US
Telephone Number	:	310-216-7109
Fax Number	:	310-645-0322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/09/2010

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