Provider Demographics
NPI:1316091994
Name:SOUTHWEST PSYCHOLOGY ASSCIATES
Entity type:Organization
Organization Name:SOUTHWEST PSYCHOLOGY ASSCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-388-4100
Mailing Address - Street 1:301 W COLLEGE AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5002
Mailing Address - Country:US
Mailing Address - Phone:505-388-4100
Mailing Address - Fax:
Practice Address - Street 1:301 W COLLEGE AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5002
Practice Address - Country:US
Practice Address - Phone:505-388-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006042101YP2500X
NM693103TC0700X
NMI22421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK2218Medicaid
NMK2218Medicaid