Provider Demographics
NPI:1578611265
Name:LUTZ, RICHARD BROCK (LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BROCK
Last Name:LUTZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2543
Mailing Address - Country:US
Mailing Address - Phone:216-661-1508
Mailing Address - Fax:
Practice Address - Street 1:750 ABBE RD S
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7246
Practice Address - Country:US
Practice Address - Phone:440-323-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0500378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional