MEDICARE: MS. CHRISTINE MILLBURN LUTTRELL M.S.

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	101YP2500X	Professional Counselor	0381	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	610661458	OTHER	KY	TAX ID

General Provider Information

NPI Number	:	1992007314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE MILLBURN LUTTRELL M.S.

Provider Business Mailing Address
First Line	:	146 MOHAWK DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-5412
Country	:	US
Telephone Number	:	720-557-3574
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 MOHAWK DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-5412
Country	:	US
Telephone Number	:	720-557-3574
Fax Number	:

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

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	02/02/2026

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