Healthcare Provider Details

I. General information

NPI: 1154822310
Provider Name (Legal Business Name): STEPHANY LUTZ M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16086 HARLEM AVE
TINLEY PARK IL
60477-1612
US

IV. Provider business mailing address

16086 HARLEM AVE
TINLEY PARK IL
60477-1612
US

V. Phone/Fax

Practice location:
  • Phone: 708-358-7239
  • Fax: 779-216-3069
Mailing address:
  • Phone: 708-505-8177
  • Fax: 779-216-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-34076
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: