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General NPI Number Information
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NPI Number | 1578611265
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Entity Type | Individual
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Provider Name | RICHARD BROCK LUTZ LPC
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 750 ABBE RD S
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City | ELYRIA
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State | OH
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Zip | 44035-7246
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Country | US
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Telephone | 440-323-5121
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Fax |
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Provider Business Mailing Address
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Address Line | 8612 ORCHARD AVE
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City | BROOKLYN
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State | OH
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Zip | 44144-2543
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Country | US
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Telephone | 216-661-1508
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Fax |
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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 | C.0500378
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License Number State | OH
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