Provider Demographics
NPI:1609216878
Name:HUTCHINSON, DERIK DESIRAY (LPC)
Entity Type:Individual
Prefix:MR
First Name:DERIK
Middle Name:DESIRAY
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 N VELASCO ST
Mailing Address - Street 2:STE 300
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3179
Mailing Address - Country:US
Mailing Address - Phone:832-457-3540
Mailing Address - Fax:281-377-5870
Practice Address - Street 1:2512 N VELASCO ST
Practice Address - Street 2:STE 300
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3179
Practice Address - Country:US
Practice Address - Phone:832-457-3540
Practice Address - Fax:281-377-5870
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional