Provider Demographics
NPI:1679251698
Name:LUTHER, BRIANNA ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ELAINE
Last Name:LUTHER
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 1:1656 N PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5181
Mailing Address - Country:US
Mailing Address - Phone:580-216-7242
Mailing Address - Fax:
Practice Address - Street 1:128 SOUTHWINDS RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8678
Practice Address - Country:US
Practice Address - Phone:580-216-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11239-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical