Healthcare Provider Details

I. General information

NPI: 1932815834
Provider Name (Legal Business Name): KATIE SUE HUTSON MA, LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 HOUSTON RD STE 2
FLORENCE KY
41042-4874
US

IV. Provider business mailing address

6900 HOUSTON RD
FLORENCE KY
41042-4884
US

V. Phone/Fax

Practice location:
  • Phone: 310-619-8989
  • Fax:
Mailing address:
  • Phone: 310-619-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number280628
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number280628
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: