Provider Demographics
NPI:1730438227
Name:HUTMAN, THEODORE MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:MICHAEL
Last Name:HUTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 WESTWOOD PLZ
Mailing Address - Street 2:RM 68-237
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1759
Mailing Address - Country:US
Mailing Address - Phone:310-825-8866
Mailing Address - Fax:310-825-2682
Practice Address - Street 1:760 WESTWOOD PLZ
Practice Address - Street 2:RM 68-237
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1759
Practice Address - Country:US
Practice Address - Phone:310-825-8866
Practice Address - Fax:310-825-2682
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25204101YM0800X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health