Provider Demographics
NPI:1790709178
Name:LUTZ, GEORGE WINSTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WINSTON
Last Name:LUTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W GRAND AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8641
Mailing Address - Country:US
Mailing Address - Phone:847-265-1988
Mailing Address - Fax:
Practice Address - Street 1:95 W GRAND AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8641
Practice Address - Country:US
Practice Address - Phone:847-265-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical