Healthcare Provider Details

I. General information

NPI: 1215355623
Provider Name (Legal Business Name): MARSHA HUTCHISON MHS, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 EDENBORN AVE
METAIRIE LA
70002
US

IV. Provider business mailing address

2637 EDENBORN AVE
METAIRIE LA
70002-7045
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-2446
  • Fax:
Mailing address:
  • Phone: 504-455-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1368
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: