Provider Demographics
NPI:1366987703
Name:HUTCHINSON, CARLYE CARPENTER
Entity type:Individual
Prefix:
First Name:CARLYE
Middle Name:CARPENTER
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 MILESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6888
Mailing Address - Country:US
Mailing Address - Phone:662-255-3568
Mailing Address - Fax:901-861-5516
Practice Address - Street 1:165 N MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2656
Practice Address - Country:US
Practice Address - Phone:901-286-4017
Practice Address - Fax:901-861-5516
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional