Provider Demographics
NPI:1205533189
Name:HUTCHINSON, BROC GIANNI III
Entity type:Individual
Prefix:MR
First Name:BROC
Middle Name:GIANNI
Last Name:HUTCHINSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 E SHEA BLVD STE 164
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4686
Mailing Address - Country:US
Mailing Address - Phone:678-643-8309
Mailing Address - Fax:
Practice Address - Street 1:5040 E SHEA BLVD STE 164
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4686
Practice Address - Country:US
Practice Address - Phone:678-643-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)