Provider Demographics
NPI:1396217840
Name:HUTTON, JEREMY DARRYL (AMFT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DARRYL
Last Name:HUTTON
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ANTELOPE BLVD
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2807
Mailing Address - Country:US
Mailing Address - Phone:530-727-9423
Mailing Address - Fax:
Practice Address - Street 1:20 ANTELOPE BLVD
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2807
Practice Address - Country:US
Practice Address - Phone:530-727-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT109504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist