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General NPI Number Information
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NPI Number | 1952309395
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Entity Type | Individual
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Provider Name | CANDIDA JANE LUTES PHD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 3500 OAK LAWN AVE. SUITE 275
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City | DALLAS
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State | TX
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Zip | 75219-4308
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Country | US
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Telephone | 214-522-0498
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Fax | 214-522-0454
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Provider Business Mailing Address
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Address Line | 3500 OAK LAWN AVE. SUITE 275
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City | DALLAS
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State | TX
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Zip | 75219-4308
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Country | US
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Telephone | 214-522-0498
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Fax | 214-522-0454
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 21711
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 21711
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License Number State | TX
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