Provider Demographics
NPI:1235642323
Name:LUTZ, REBECCA MARLENE (CADC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARLENE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARLENE
Other - Last Name:TROOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:VASSAR
Mailing Address - State:MI
Mailing Address - Zip Code:48768-9584
Mailing Address - Country:US
Mailing Address - Phone:989-823-3040
Mailing Address - Fax:
Practice Address - Street 1:150 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:VASSAR
Practice Address - State:MI
Practice Address - Zip Code:48768-9584
Practice Address - Country:US
Practice Address - Phone:989-823-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01493101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)