Provider Demographics
NPI:1740927953
Name:HUTCHINS KHAN, REBEKAH JAN (PHD)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:JAN
Last Name:HUTCHINS KHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1103
Mailing Address - Country:US
Mailing Address - Phone:505-595-3505
Mailing Address - Fax:505-581-3291
Practice Address - Street 1:4225 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1103
Practice Address - Country:US
Practice Address - Phone:505-595-3505
Practice Address - Fax:505-581-3291
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0200X, 103TF0200X
NMCTB-2024-0610101YP2500X
NMCTB-2022-0120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000265OtherPHD/ FORENSIC EVALUATOR