Provider Demographics
NPI:1467822015
Name:LUTTRELL, LAUREN KAREN
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:KAREN
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GLAD VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-2617
Mailing Address - Country:US
Mailing Address - Phone:978-930-3256
Mailing Address - Fax:
Practice Address - Street 1:44 GLAD VALLEY DR
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-2617
Practice Address - Country:US
Practice Address - Phone:978-930-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health