Healthcare Provider Details

I. General information

NPI: 1821696287
Provider Name (Legal Business Name): MARILYN HUTCHERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4185 VEGAS VALLEY DR STE B
LAS VEGAS NV
89121-2522
US

IV. Provider business mailing address

987 SABLE CHASE PL
HENDERSON NV
89011-2573
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-9066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: