Healthcare Provider Details

I. General information

NPI: 1255803235
Provider Name (Legal Business Name): GRACE LYNN FLUTY MAE.D., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE LYNN DUSEK

II. Dates (important events)

Enumeration Date: 01/01/2019
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MULL AVE
AKRON OH
44313-7502
US

IV. Provider business mailing address

2680 W MARKET ST
FAIRLAWN OH
44333-4215
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-5603
  • Fax:
Mailing address:
  • Phone: 234-867-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1801264-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: