Provider Demographics
NPI:1861277014
Name:HUTCHINSON, QUENTIN (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 FORREST PARK CV
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-3923
Mailing Address - Country:US
Mailing Address - Phone:901-659-2884
Mailing Address - Fax:
Practice Address - Street 1:7075 GOLDEN OAKS LOOP W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9010
Practice Address - Country:US
Practice Address - Phone:662-228-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS200035103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst