Healthcare Provider Details

I. General information

NPI: 1841939444
Provider Name (Legal Business Name): NELLE STEPHAN-LUTZ, EDS, LMFT, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 NW 41ST ST STE D3
GAINESVILLE FL
32606-6666
US

IV. Provider business mailing address

2630 NW 41ST ST STE D3
GAINESVILLE FL
32606-6666
US

V. Phone/Fax

Practice location:
  • Phone: 352-378-7526
  • Fax:
Mailing address:
  • Phone: 352-378-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. NELLE STEPHAN-LUTZ
Title or Position: OWNER
Credential:
Phone: 352-378-7526