Provider Demographics
NPI:1508878182
Name:LUTZ, RONALD LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:LUTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 S TEXAS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4040
Mailing Address - Country:US
Mailing Address - Phone:979-361-7907
Mailing Address - Fax:979-846-6557
Practice Address - Street 1:4103 S TEXAS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4040
Practice Address - Country:US
Practice Address - Phone:979-361-7907
Practice Address - Fax:979-846-6557
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4098103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP10POtherBLUE CROSS/BLUE SHIELD