Provider Demographics
NPI:1114269743
Name:LUTHRA, BHAWNA (MA,LPC,LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BHAWNA
Middle Name:
Last Name:LUTHRA
Suffix:
Gender:F
Credentials:MA,LPC,LMFT
Other - Prefix:MRS
Other - First Name:BHAWNA
Other - Middle Name:
Other - Last Name:LUTHRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT,LPC
Mailing Address - Street 1:3131 RICHARD LANE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546
Mailing Address - Country:US
Mailing Address - Phone:832-736-4325
Mailing Address - Fax:
Practice Address - Street 1:16821 BUCCANEER LANE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77546
Practice Address - Country:US
Practice Address - Phone:832-736-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66044101YM0800X
TX201554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist