Healthcare Provider Details

I. General information

NPI: 1720145774
Provider Name (Legal Business Name): HUTNER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 MALLARD COVE LN
FORT WAYNE IN
46804-2883
US

IV. Provider business mailing address

3240 MALLARD COVE LN
FORT WAYNE IN
46804-2883
US

V. Phone/Fax

Practice location:
  • Phone: 260-341-5848
  • Fax: 260-755-5927
Mailing address:
  • Phone: 260-341-5848
  • Fax: 260-755-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20041381A
License Number StateIN

VIII. Authorized Official

Name: DR. BRIAN DOUGLAS HUTNER
Title or Position: PRESIDENT
Credential: PSY.D., HSPP
Phone: 260-341-5848