Provider Demographics
NPI:1649595307
Name:LUTTRELL, AFTON MAE (LMSW, MSW U-S)
Entity Type:Individual
Prefix:MRS
First Name:AFTON
Middle Name:MAE
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:LMSW, MSW U-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10321 N 2274 RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-7521
Mailing Address - Country:US
Mailing Address - Phone:580-331-3485
Mailing Address - Fax:580-331-3569
Practice Address - Street 1:10321 N 2274 RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-7521
Practice Address - Country:US
Practice Address - Phone:580-331-3485
Practice Address - Fax:580-331-3569
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100707910BMedicaid