Healthcare Provider Details

I. General information

NPI: 1629586656
Provider Name (Legal Business Name): SHAWNDEAN HUTCHISON LPC, BC-TMH, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 11/12/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7362 W PARKS HWY STE 456
WASILLA AK
99623-9300
US

IV. Provider business mailing address

PO BOX 521462
BIG LAKE AK
99652-1462
US

V. Phone/Fax

Practice location:
  • Phone: 907-671-0160
  • Fax: 833-789-0336
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number128458
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: