Provider Demographics
NPI:1649326810
Name:HUTCHINSON, GRANT L (PHD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:L
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 H ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4418
Mailing Address - Country:US
Mailing Address - Phone:916-444-6386
Mailing Address - Fax:916-448-4196
Practice Address - Street 1:730 ALHAMBRA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3847
Practice Address - Country:US
Practice Address - Phone:916-444-8012
Practice Address - Fax:916-444-4451
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4023103G00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic