Provider Demographics
NPI:1972661718
Name:HUTSON, JOANN GILLESS
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:GILLESS
Last Name:HUTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JO ANN
Other - Middle Name:GILLESS
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 WEST CARMEN LANE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1210
Mailing Address - Country:US
Mailing Address - Phone:805-739-0582
Mailing Address - Fax:805-739-8647
Practice Address - Street 1:212 CARMEN LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7769
Practice Address - Country:US
Practice Address - Phone:805-739-0582
Practice Address - Fax:805-739-8647
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health