Healthcare Provider Details

I. General information

NPI: 1992353205
Provider Name (Legal Business Name): MATTHEW HUTSON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 N REYNOLDS RD STE 1
BRYANT AR
72022-2501
US

IV. Provider business mailing address

2213 N REYNOLDS RD STE 1
BRYANT AR
72022-2501
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-0081
  • Fax: 501-847-6905
Mailing address:
  • Phone: 501-847-0081
  • Fax: 501-847-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9559-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: