Provider Demographics
NPI:1689150039
Name:LUTZ, NATHANIEL WALTER (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:WALTER
Last Name:LUTZ
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-6337
Mailing Address - Country:US
Mailing Address - Phone:207-214-2618
Mailing Address - Fax:
Practice Address - Street 1:11 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1368
Practice Address - Country:US
Practice Address - Phone:207-214-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5863101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor