MEDICARE: CHRISTY ANN CLARK HUTTON PHD

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	103TC1900X	Counseling Psychologist	2006029908	MO

General Provider Information

NPI Number	:	1972640597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY ANN CLARK HUTTON PHD

Provider Business Mailing Address
First Line	:	2710 FORUM BLVD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5433
Country	:	US
Telephone Number	:	573-474-1292
Fax Number	:	573-474-1295

Provider Business Practice Location Address
First Line	:	2710 FORUM BLVD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5433
Country	:	US
Telephone Number	:	573-474-1292
Fax Number	:	573-474-1295

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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