Healthcare Provider Details

I. General information

NPI: 1255108395
Provider Name (Legal Business Name): JAMES DANIEL HUTTO IV LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E DIEHL RD STE 101
NAPERVILLE IL
60563-2394
US

IV. Provider business mailing address

4119 GLENDENNING RD
DOWNERS GROVE IL
60515-2226
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.019652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: