Provider Demographics
NPI:1700516986
Name:HUTTON, MICAH JON (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICAH
Middle Name:JON
Last Name:HUTTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 KOPECKY RD
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6923
Mailing Address - Country:US
Mailing Address - Phone:334-310-1431
Mailing Address - Fax:
Practice Address - Street 1:2140 UPPER WETUMPKA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-1342
Practice Address - Country:US
Practice Address - Phone:334-279-7830
Practice Address - Fax:334-270-1647
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT21263183700000X
ALLPC05074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No183700000XPharmacy Service ProvidersPharmacy Technician