MEDICARE: MR. JAMES DAVID LUTTRALL LPC, LAC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1962147041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES DAVID LUTTRALL LPC, LAC

Provider Business Mailing Address
First Line	:	1295 GLENROCK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926-9626
Country	:	US
Telephone Number	:	719-291-2439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 GLENROCK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926-9626
Country	:	US
Telephone Number	:	719-291-2439
Fax Number	:

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

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	05/03/2022

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