Provider Demographics
NPI:1053153528
Name:LUTTRELL, STEFANIE NICHOLE (LPC-A)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:NICHOLE
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 MOUNTAIN WOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4648
Mailing Address - Country:US
Mailing Address - Phone:361-585-3866
Mailing Address - Fax:
Practice Address - Street 1:5959 S STAPLES ST STE 206
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3844
Practice Address - Country:US
Practice Address - Phone:361-389-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty