Healthcare Provider Details

I. General information

NPI: 1568580868
Provider Name (Legal Business Name): LARRY T. HUTCHINSON LMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD SUITE # 207
OMAHA NE
68124-1900
US

IV. Provider business mailing address

5019 GIFFORD RD
COUNCIL BLUFFS IA
51501-8286
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1177
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: