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General NPI Number Information
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NPI Number | 1386662294
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Entity Type | Individual
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Provider Name | LARRY W LUTZ II MS
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 210 N 3RD E
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2733
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Country | US
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Telephone | 208-284-0959
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Fax | 208-587-4269
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Provider Business Mailing Address
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Address Line | 210 N 3RD E
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2733
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Country | US
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Telephone | 208-284-0959
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Fax | 208-587-4269
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-4128
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License Number State | ID
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