Healthcare Provider Details

I. General information

NPI: 1821116567
Provider Name (Legal Business Name): MS. DEBRA LYNN LUTHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 W. MARTIN LUTHER KING BLVD.
FRESNO CA
93706
US

IV. Provider business mailing address

4875 E BROWN AVE
FRESNO CA
93703-1624
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-4800
  • Fax: 559-265-4823
Mailing address:
  • Phone: 559-253-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: