Healthcare Provider Details

I. General information

NPI: 1841344256
Provider Name (Legal Business Name): LARISA K HUTCHINS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 MARSH RD SUITE 16
OKEMOS MI
48864-2143
US

IV. Provider business mailing address

1563 W POND DR UNIT 34
OKEMOS MI
48864-2386
US

V. Phone/Fax

Practice location:
  • Phone: 517-420-2788
  • Fax: 517-347-7892
Mailing address:
  • Phone: 517-347-2583
  • Fax: 517-347-7892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301008832
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: