Basic Information
| Provider Information | |||||||||
| NPI: | 1932148558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUTCHISON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 4 BOX 4515 | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639579417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732234233 | ||||||||
| FaxNumber: | 5732232136 | ||||||||
| Practice Location | |||||||||
| Address1: | RR 4 BOX 4515 | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639579417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732234233 | ||||||||
| FaxNumber: | 5732232136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 09/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 000907 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2078586 | 01 | FIRST HEALTH/COVENTRY | OTHER | 494975212 | 05 | MO | MEDICAID | 2255 | 01 | EAP IMPACT | OTHER | 179816 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 431116734 | 01 | EAP CONCERN | OTHER | 431116734 | 01 | NEW DIRECTIONS | OTHER | 431116734 | 01 | UNITED BEHAVIORAL HEALTH | OTHER | 11333395 | 01 | CAQH | OTHER | 431116734 | 01 | EAP PEOPLE RESOURCES | OTHER | 431116734 | 01 | EAP INTERFACE | OTHER | 713315 | 01 | HEALTHLINK PPO | OTHER |