Basic Information
Provider Information
NPI: 1063666550
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILTON
FirstName: ADAM
MiddleName: SCOTT
NamePrefix:  
NameSuffix:  
Credential: LMFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 400
Address2:  
City: RED BLUFF
State: CA
PostalCode: 960800400
CountryCode: US
TelephoneNumber: 5305278491
FaxNumber: 5305270249
Practice Location
Address1: 1860 WALNUT ST
Address2:  
City: RED BLUFF
State: CA
PostalCode: 960803611
CountryCode: US
TelephoneNumber: 5305278491
FaxNumber: 5305270249
Other Information
ProviderEnumerationDate: 11/10/2008
LastUpdateDate: 04/14/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMFC 52499CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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