Basic Information
| Provider Information | |||||||||
| NPI: | 1639647811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUTCHENS | ||||||||
| FirstName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 MONTEBELLO RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810011366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195452746 | ||||||||
| FaxNumber: | 7195429638 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 W ABRIENDO AVE | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810041870 | ||||||||
| CountryCode: | US | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2018 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ACC.0997924 | CO | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | ACB.0007924 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | ACC.0997924 | 01 | CO | CERTIFIED ADDICTIONS SPECIALIST | OTHER |