Basic Information
| Provider Information | |||||||||
| NPI: | 1578525135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUTCHINSON | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 W COLLEGE AVE | ||||||||
| Address2: | SUITE 16 | ||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880615002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753138222 | ||||||||
| FaxNumber: | 5753138226 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 W COLLEGE AVE | ||||||||
| Address2: | SUITE 16 | ||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880615002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753138222 | ||||||||
| FaxNumber: | 5753138226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 693 | NM | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | Z2383 | 05 | NM | MEDICAID |