MEDICARE: CHRISTINE LUTHER MA LLP

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	103TC0700X	Clinical Psychologist	6361005096	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629270434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LUTHER MA LLP

Provider Business Mailing Address
First Line	:	19445 W WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-3361
Country	:	US
Telephone Number	:	313-307-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	19445 W WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-3361
Country	:	US
Telephone Number	:	313-307-0088
Fax Number	:	313-281-2235

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	12/01/2021

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Directions to “ CHRISTINE LUTHER MA LLP” Practice Location

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