Healthcare Provider Details

I. General information

NPI: 1285211011
Provider Name (Legal Business Name): CHRISTIAN LARAY HUTCHINGS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 ADELINE ST
BERKELEY CA
94703-2407
US

IV. Provider business mailing address

284 CLIFF WALK DR
VALLEJO CA
94591-6434
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-0203
  • Fax: 510-601-4002
Mailing address:
  • Phone: 707-384-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSB94025624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSB94025624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: