Healthcare Provider Details

I. General information

NPI: 1487198891
Provider Name (Legal Business Name): MICHAEL HUTT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 SW 2ND ST STE A-104
BEAVERTON OR
97005-2828
US

IV. Provider business mailing address

90 S KYRENE RD STE 1
CHANDLER AZ
85226-4687
US

V. Phone/Fax

Practice location:
  • Phone: 503-389-0206
  • Fax:
Mailing address:
  • Phone: 480-815-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-15415
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: