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NPI Code Detail

MEDICARE: TINA LUTHER MA

MEDICARE: TINA LUTHER MA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1720466360
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA LUTHER MA
Provider Business Mailing Address
First Line : 240 N TILLOTSON AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47304-3988
Country : US
Telephone Number : 765-288-1928
Fax Number : 765-741-0335
Provider Business Practice Location Address
First Line : 931 W WATER ST
Second Line :
City : PORTLAND
State : IN
Zip : 47371-1755
Country : US
Telephone Number : 260-726-9348
Fax Number : 260-726-9340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2015
Last Update Date : 06/19/2015

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Directions to “ TINA LUTHER MA” Practice Location

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