Provider Demographics
NPI:1558938985
Name:LUTTRELL, MCKAYLA (MED, BCBA, RBT)
Entity Type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:MED, BCBA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 CENTRAL POINT RD
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-4663
Mailing Address - Country:US
Mailing Address - Phone:865-356-3624
Mailing Address - Fax:
Practice Address - Street 1:6004 WALDEN DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6370
Practice Address - Country:US
Practice Address - Phone:865-766-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst