Provider Demographics
NPI:1932148558
Name:HUTCHISON, MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 4515
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-9417
Mailing Address - Country:US
Mailing Address - Phone:573-223-4233
Mailing Address - Fax:573-223-2136
Practice Address - Street 1:RR 4 BOX 4515
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-9417
Practice Address - Country:US
Practice Address - Phone:573-223-4233
Practice Address - Fax:573-223-2136
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0009071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2078586OtherFIRST HEALTH/COVENTRY
MO494975212Medicaid
2255OtherEAP IMPACT
179816OtherBLUE CROSS BLUE SHIELD
431116734OtherEAP CONCERN
431116734OtherNEW DIRECTIONS
431116734OtherUNITED BEHAVIORAL HEALTH
11333395OtherCAQH
431116734OtherEAP PEOPLE RESOURCES
431116734OtherEAP INTERFACE
713315OtherHEALTHLINK PPO
431116734OtherNEW DIRECTIONS
MO990201757Medicare PIN