Provider Demographics
NPI:1295159515
Name:HUTCHISON, KENTON
Entity type:Individual
Prefix:
First Name:KENTON
Middle Name:
Last Name:HUTCHISON
Suffix:
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 1:19562 VENTURA BLVD STE 233
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6059
Mailing Address - Country:US
Mailing Address - Phone:818-705-6363
Mailing Address - Fax:
Practice Address - Street 1:19562 VENTURA BLVD STE 233
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6059
Practice Address - Country:US
Practice Address - Phone:818-705-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)