MEDICARE: SHANA EVE LUTKER LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	163659	CA

General Provider Information

NPI Number	:	1548192008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA EVE LUTKER LMFT

Provider Business Mailing Address
First Line	:	3043 ROSSLYN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1408
Country	:	US
Telephone Number	:	213-804-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 RUBY ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2722
Country	:	US
Telephone Number	:	323-488-8723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ SHANA EVE LUTKER LMFT” Practice Location

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