Provider Demographics
NPI:1376536102
Name:STEPHAN-LUTZ, NELLE M (EDS, MHC, LMFT)
Entity Type:Individual
Prefix:
First Name:NELLE
Middle Name:M
Last Name:STEPHAN-LUTZ
Suffix:
Gender:F
Credentials:EDS, MHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 NW 41ST ST
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7495
Mailing Address - Country:US
Mailing Address - Phone:352-378-7526
Mailing Address - Fax:352-378-7530
Practice Address - Street 1:2630 NW 41ST ST
Practice Address - Street 2:SUITE D-3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7495
Practice Address - Country:US
Practice Address - Phone:352-378-7526
Practice Address - Fax:352-378-7530
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6477101YM0800X
FLMT 1867106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist