Provider Demographics
NPI:1306699780
Name:HUTTER, JEFFREY I (CLINICAL PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
Last Name:HUTTER
Suffix:
Gender:M
Credentials:CLINICAL PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WILSHIRE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2335
Mailing Address - Country:US
Mailing Address - Phone:310-458-7112
Mailing Address - Fax:
Practice Address - Street 1:3201 WILSHIRE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2335
Practice Address - Country:US
Practice Address - Phone:310-458-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical