Provider Demographics
NPI:1457022311
Name:HUTOMO, ASHLEY (AMFT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HUTOMO
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2032
Mailing Address - Country:US
Mailing Address - Phone:650-201-4201
Mailing Address - Fax:
Practice Address - Street 1:3657 RICARDO AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2627
Practice Address - Country:US
Practice Address - Phone:530-242-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist