MEDICARE: NELLE M STEPHAN-LUTZ EDS, MHC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 6477	FL
2	106H00000X	Marriage & Family Therapist	MT 1867	FL

General Provider Information

NPI Number	:	1376536102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELLE M STEPHAN-LUTZ EDS, MHC, LMFT

Provider Business Mailing Address
First Line	:	2630 NW 41ST ST
Second Line	:	SUITE D-3
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-7495
Country	:	US
Telephone Number	:	352-378-7526
Fax Number	:	352-378-7530

Provider Business Practice Location Address
First Line	:	2630 NW 41ST ST
Second Line	:	SUITE D-3
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-7495
Country	:	US
Telephone Number	:	352-378-7526
Fax Number	:	352-378-7530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	09/11/2025

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