Healthcare Provider Details

I. General information

NPI: 1306244991
Provider Name (Legal Business Name): LAURA HUTT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 OAK ST
NORTHPORT NY
11768-2036
US

IV. Provider business mailing address

95 OAK ST
NORTHPORT NY
11768-2036
US

V. Phone/Fax

Practice location:
  • Phone: 516-000-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: