Provider Demographics
NPI:1952479388
Name:LUTTRELL, MARY LOU (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARY LOU
Middle Name:
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COLUMBIA ST NW STE E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1062
Mailing Address - Country:US
Mailing Address - Phone:360-754-2102
Mailing Address - Fax:360-786-1572
Practice Address - Street 1:501 COLUMBIA ST NW STE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1062
Practice Address - Country:US
Practice Address - Phone:360-754-2102
Practice Address - Fax:360-786-1572
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health