Provider Demographics
NPI:1639609845
Name:LUTTS, ANGELA M (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:LUTTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 COLLEYVILLE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5818
Mailing Address - Country:US
Mailing Address - Phone:817-918-7300
Mailing Address - Fax:
Practice Address - Street 1:5005 COLLEYVILLE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5818
Practice Address - Country:US
Practice Address - Phone:817-918-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX413771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical