Healthcare Provider Details

I. General information

NPI: 1164040614
Provider Name (Legal Business Name): MARK E HUTCHINSON LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5047 S GALLERIA DRIVE
MURRAY UT
84123
US

IV. Provider business mailing address

5047 S GALLERIA DRIVE
MURRAY UT
84123
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-8143
  • Fax: 801-746-6090
Mailing address:
  • Phone: 801-486-8143
  • Fax: 801-746-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: