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General NPI Number Information
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NPI Number | 1114158227
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Entity Type | Individual
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Provider Name | JOSHUA ANTHONY LUTZ ED,S, NCSP
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Gender | Male
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 91 BAY BRIDGE DR SUITE D
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City | GULF BREEZE
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State | FL
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Zip | 32561-4468
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Country | US
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Telephone | 866-960-8806
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Fax | 866-960-8806
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Provider Business Mailing Address
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Address Line | 91 BAY BRIDGE DR SUITE D
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City | GULF BREEZE
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State | FL
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Zip | 32561-4468
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Country | US
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Telephone | 866-960-8806
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Fax | 866-960-8806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SS795
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License Number State | FL
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