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General NPI Number Information
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NPI Number | 1700516986
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Entity Type | Individual
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Provider Name | MICAH JON HUTTON LPC
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Gender | Male
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Dates
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Enumeration Date | 06/12/2022
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 2140 UPPER WETUMPKA RD
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City | MONTGOMERY
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State | AL
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Zip | 36107-1342
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Country | US
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Telephone | 334-279-7830
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Fax | 334-270-1647
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Provider Business Mailing Address
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Address Line | 208 KOPECKY RD
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City | SELMA
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State | AL
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Zip | 36701-6923
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Country | US
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Telephone | 334-310-1431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | T21263
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC05074
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License Number State | AL
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