Healthcare Provider Details

I. General information

NPI: 1730839325
Provider Name (Legal Business Name): MICHAEL LUTZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 N 16TH ST
MILWAUKEE WI
53205-1626
US

IV. Provider business mailing address

2531 N WEIL ST
MILWAUKEE WI
53212-3024
US

V. Phone/Fax

Practice location:
  • Phone: 414-977-0001
  • Fax:
Mailing address:
  • Phone: 414-712-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7740125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: