Healthcare Provider Details

I. General information

NPI: 1528507712
Provider Name (Legal Business Name): BRANDON HUTCHINSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6972 HILLOCK FR
COLORADO SPRINGS CO
80922
US

IV. Provider business mailing address

6972 HILLOCK DR
COLORADO SPRINGS CO
80922-4301
US

V. Phone/Fax

Practice location:
  • Phone: 719-440-2726
  • Fax:
Mailing address:
  • Phone: 719-440-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923314
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: