Healthcare Provider Details

I. General information

NPI: 1336444801
Provider Name (Legal Business Name): STANCIL JOSEPH LISTER HUTCHINSON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 ALHAMBRA BLVD. SUITE 205
SACRAMENTO CA
95816
US

IV. Provider business mailing address

730 ALHAMBRA BLVD. SUITE 205
SACRAMENTO CA
95816
US

V. Phone/Fax

Practice location:
  • Phone: 916-849-6251
  • Fax: 916-444-4451
Mailing address:
  • Phone: 916-849-6251
  • Fax: 916-444-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 23928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: