Healthcare Provider Details

I. General information

NPI: 1548729908
Provider Name (Legal Business Name): ROBERT HUTCHENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 WABASH CT
TERRE HAUTE IN
47807-3439
US

IV. Provider business mailing address

620 8TH AVE
TERRE HAUTE IN
47804-2771
US

V. Phone/Fax

Practice location:
  • Phone: 812-231-8171
  • Fax: 812-238-3871
Mailing address:
  • Phone: 812-231-8438
  • Fax: 812-231-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003479A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: