Provider Demographics
NPI:1144117730
Name:LUTZ, KRISTINE L (MA, LMFT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:LUTZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LONG LAKE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6439
Mailing Address - Country:US
Mailing Address - Phone:651-482-9361
Mailing Address - Fax:
Practice Address - Street 1:900 LONG LAKE RD STE 320
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6439
Practice Address - Country:US
Practice Address - Phone:651-482-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist