Healthcare Provider Details

I. General information

NPI: 1144167214
Provider Name (Legal Business Name): FOURRIVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 N LARRABEE ST APT 803
CHICAGO IL
60654-6452
US

IV. Provider business mailing address

758 N LARRABEE ST APT 803
CHICAGO IL
60654-6452
US

V. Phone/Fax

Practice location:
  • Phone: 608-963-4669
  • Fax:
Mailing address:
  • Phone: 608-963-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WILLIAM JOSEPH HUTTER
Title or Position: CLINICAL PSYCHOTHERAPIST
Credential: PSYD, LMFT
Phone: 608-963-4669