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General NPI Number Information
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NPI Number | 1649819145
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Entity Type | Individual
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Provider Name | ELLEN J. LUTZ L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 2031 E CALUMET ST.
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City | APPLETON
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State | WI
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Zip | 54915-4742
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Country | US
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Telephone | 920-809-6766
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Fax | 920-358-7535
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Provider Business Mailing Address
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Address Line | 2406 E BONA AVE
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City | APPLETON
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State | WI
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Zip | 54915-3657
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Country | US
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Telephone | 920-809-6766
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Fax | 920-358-7535
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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