Provider Demographics
NPI:1972640597
Name:HUTTON, CHRISTY ANN CLARK (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ANN CLARK
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 1:2710 FORUM BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5433
Mailing Address - Country:US
Mailing Address - Phone:573-474-1292
Mailing Address - Fax:573-474-1295
Practice Address - Street 1:2710 FORUM BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5433
Practice Address - Country:US
Practice Address - Phone:573-474-1292
Practice Address - Fax:573-474-1295
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029908103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling