Provider Demographics
NPI:1841344256
Name:HUTCHINS, LARISA K (PSYD)
Entity type:Individual
Prefix:DR
First Name:LARISA
Middle Name:K
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 W POND DR
Mailing Address - Street 2:UNIT 34
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2386
Mailing Address - Country:US
Mailing Address - Phone:517-347-2583
Mailing Address - Fax:517-347-7892
Practice Address - Street 1:4660 MARSH RD
Practice Address - Street 2:SUITE 16
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2143
Practice Address - Country:US
Practice Address - Phone:517-420-2788
Practice Address - Fax:517-347-7892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION49740Medicare ID - Type Unspecified
MIP01605Medicare UPIN