Healthcare Provider Details

I. General information

NPI: 1730272782
Provider Name (Legal Business Name): MICHELLE HUTCHISON M.C., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 N 113TH AVE SUITE B-9
YOUNGTOWN AZ
85363-1162
US

IV. Provider business mailing address

14863 W CORTEZ ST
SURPRISE AZ
85379-5226
US

V. Phone/Fax

Practice location:
  • Phone: 623-330-9035
  • Fax:
Mailing address:
  • Phone: 623-330-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10991
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: