Provider Demographics
NPI:1790080026
Name:HUTTON, DEBRA GLENN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:GLENN
Last Name:HUTTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1907
Mailing Address - Country:US
Mailing Address - Phone:517-783-5334
Mailing Address - Fax:517-783-6064
Practice Address - Street 1:602 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1907
Practice Address - Country:US
Practice Address - Phone:517-783-5334
Practice Address - Fax:517-783-6064
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014733103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist