Healthcare Provider Details

I. General information

NPI: 1528428984
Provider Name (Legal Business Name): CHRISTINE JOY HUTTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2016
Last Update Date: 02/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12041 RAVENNA RD
CHARDON OH
44024-7008
US

IV. Provider business mailing address

2394 PLEASANT PL
MADISON OH
44057-2336
US

V. Phone/Fax

Practice location:
  • Phone: 440-286-7154
  • Fax:
Mailing address:
  • Phone: 440-286-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE. 0600593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: