Provider Demographics
NPI:1073817128
Name:MATTHEW HUTT GROUP, LLC
Entity Type:Organization
Organization Name:MATTHEW HUTT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HUTT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:308-632-8080
Mailing Address - Street 1:2208 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1970
Mailing Address - Country:US
Mailing Address - Phone:308-632-8080
Mailing Address - Fax:308-632-8084
Practice Address - Street 1:2208 BROADWAY
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1970
Practice Address - Country:US
Practice Address - Phone:308-632-8080
Practice Address - Fax:308-632-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9244101YM0800X
NE331103T00000X
NE393103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025917000Medicaid