Healthcare Provider Details

I. General information

NPI: 1518124494
Provider Name (Legal Business Name): JOEL HUTCHINSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 S DOBSON RD SUITE 213
MESA AZ
85202-5661
US

IV. Provider business mailing address

1845 S DOBSON RD SUITE 213
MESA AZ
85202-5661
US

V. Phone/Fax

Practice location:
  • Phone: 480-466-6397
  • Fax: 480-820-0239
Mailing address:
  • Phone: 480-466-6397
  • Fax: 480-820-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1440
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: