Provider Demographics
NPI:1386443695
Name:HUTSON, KATIE BREANN (BCBA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:BREANN
Last Name:HUTSON
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COUNTY ROAD 2315
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-8113
Mailing Address - Country:US
Mailing Address - Phone:318-498-2760
Mailing Address - Fax:
Practice Address - Street 1:6040 I 55 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2641
Practice Address - Country:US
Practice Address - Phone:318-498-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1-25-79628103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst