Provider Demographics
NPI:1184213803
Name:HUTTON, KANDIS BRIANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:KANDIS
Middle Name:BRIANNE
Last Name:HUTTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 N GLASSELL ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6777
Mailing Address - Country:US
Mailing Address - Phone:657-333-2722
Mailing Address - Fax:
Practice Address - Street 1:758 N GLASSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-6777
Practice Address - Country:US
Practice Address - Phone:657-333-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty