Healthcare Provider Details

I. General information

NPI: 1457022311
Provider Name (Legal Business Name): ASHLEY HUTOMO AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3657 RICARDO AVE
REDDING CA
96002-2627
US

IV. Provider business mailing address

850 GOLD ST
REDDING CA
96001-2032
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-9007
  • Fax:
Mailing address:
  • Phone: 650-201-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number137254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: