Healthcare Provider Details

I. General information

NPI: 1407337835
Provider Name (Legal Business Name): TEENA HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37450 SCHOOLCRATF
WESTLAND MI
48150
US

IV. Provider business mailing address

37450 SCHOOLCRAFT RD
LIVONIA MI
48150-1082
US

V. Phone/Fax

Practice location:
  • Phone: 734-458-4601
  • Fax:
Mailing address:
  • Phone: 734-458-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: