Healthcare Provider Details

I. General information

NPI: 1013023563
Provider Name (Legal Business Name): JOE B LUTHER MA, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MONTOPOLIS DR
AUSTIN TX
78741-6411
US

IV. Provider business mailing address

7602 BERRYCONE CV
AUSTIN TX
78750-7931
US

V. Phone/Fax

Practice location:
  • Phone: 512-389-6503
  • Fax: 512-389-6544
Mailing address:
  • Phone: 512-794-0787
  • Fax: 512-389-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3333
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: