Healthcare Provider Details

I. General information

NPI: 1518035146
Provider Name (Legal Business Name): JOHN MOORE HUTCHISON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 ORCHARD LAKE RD
PONTIAC MI
48341-2244
US

IV. Provider business mailing address

2351 12 MILE RD
BERKLEY MI
48072-1826
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-7766
  • Fax: 248-858-7201
Mailing address:
  • Phone: 248-544-4006
  • Fax: 248-544-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085365
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: