Provider Demographics
NPI:1427658145
Name:HUTTON, CRAIG SPENCER
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:SPENCER
Last Name:HUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5522
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-5522
Mailing Address - Country:US
Mailing Address - Phone:505-297-6616
Mailing Address - Fax:505-787-2411
Practice Address - Street 1:116 N WALL AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6916
Practice Address - Country:US
Practice Address - Phone:505-297-6616
Practice Address - Fax:505-787-2411
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-109601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical