MEDICARE: HUTCHINSON PSYCHOLOGICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0374	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972043040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUTCHINSON PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1221
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67504-1221
Country	:	US
Telephone Number	:	620-663-4802
Fax Number	:	620-663-9867

Provider Business Practice Location Address
First Line	:	125 W 2ND AVE STE E
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-5263
Country	:	US
Telephone Number	:	620-663-4802
Fax Number	:	620-663-9867

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. AJ BARNES
Credential	:
Telephone Number	:	620-663-4802

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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