Provider Demographics
NPI:1578525135
Name:HUTCHINSON, KENNETH ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALLEN
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W COLLEGE AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5002
Mailing Address - Country:US
Mailing Address - Phone:575-313-8222
Mailing Address - Fax:575-313-8226
Practice Address - Street 1:301 W COLLEGE AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5002
Practice Address - Country:US
Practice Address - Phone:575-313-8222
Practice Address - Fax:575-313-8226
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM693103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ2383Medicaid
345716901Medicare PIN