Provider Demographics
NPI:1346378189
Name:LUTJENS, GLENN W (MA)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:W
Last Name:LUTJENS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 LEHMAN DR
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1469
Mailing Address - Country:US
Mailing Address - Phone:719-534-0567
Mailing Address - Fax:
Practice Address - Street 1:6270 LEHMAN DR
Practice Address - Street 2:SUITE 200E
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1469
Practice Address - Country:US
Practice Address - Phone:719-534-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist