Healthcare Provider Details

I. General information

NPI: 1396217840
Provider Name (Legal Business Name): JEREMY DARRYL HUTTON LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 WALNUT ST
RED BLUFF CA
96080-3610
US

IV. Provider business mailing address

1805 WALNUT ST
RED BLUFF CA
96080-3610
US

V. Phone/Fax

Practice location:
  • Phone: 530-727-9423
  • Fax:
Mailing address:
  • Phone: 530-727-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT125930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: