Healthcare Provider Details

I. General information

NPI: 1285261131
Provider Name (Legal Business Name): MARY HUTSON CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 HARKRIDER ST
CONWAY AR
72032-4401
US

IV. Provider business mailing address

512 S 16TH ST
FORT SMITH AR
72901-4628
US

V. Phone/Fax

Practice location:
  • Phone: 501-697-6631
  • Fax:
Mailing address:
  • Phone: 479-785-4083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: