Provider Demographics
NPI:1467508820
Name:BREWER, LUTHER GORDON JR (MED, LMFT)
Entity Type:Individual
Prefix:MR
First Name:LUTHER
Middle Name:GORDON
Last Name:BREWER
Suffix:JR
Gender:M
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-9504
Mailing Address - Country:US
Mailing Address - Phone:423-288-1777
Mailing Address - Fax:
Practice Address - Street 1:1417 WARPATH DR
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3333
Practice Address - Country:US
Practice Address - Phone:423-571-7423
Practice Address - Fax:888-395-1262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN617106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist