Provider Demographics
NPI:1558736918
Name:HUTCHINSON, TRACY (PHD, LMHC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 COLONIAL BLVD STE F41A
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1030
Mailing Address - Country:US
Mailing Address - Phone:239-931-4444
Mailing Address - Fax:
Practice Address - Street 1:1342 COLONIAL BLVD STE F41A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1030
Practice Address - Country:US
Practice Address - Phone:239-931-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
12250153OtherCAQH