Healthcare Provider Details

I. General information

NPI: 1033269675
Provider Name (Legal Business Name): KENNETH ALAN HUTCHINS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NEVADA ST STE B
REDLANDS CA
92373-4222
US

IV. Provider business mailing address

12 NEVADA ST STE B
REDLANDS CA
92373-4222
US

V. Phone/Fax

Practice location:
  • Phone: 909-422-7409
  • Fax:
Mailing address:
  • Phone: 909-422-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0PL15480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: