Provider Demographics
NPI:1982021481
Name:HUTTON, COURTNEY (ASW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HUTTON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25292
Mailing Address - Street 2:162
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5292
Mailing Address - Country:US
Mailing Address - Phone:559-312-8519
Mailing Address - Fax:559-312-8519
Practice Address - Street 1:1920 MARENGO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1317
Practice Address - Country:US
Practice Address - Phone:323-276-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA89668104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner