Provider Demographics
NPI:1003238155
Name:LUTTERODT, HENRY AUGUSTUS
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:AUGUSTUS
Last Name:LUTTERODT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:AUGUSTUS
Other - Last Name:LUTTERODT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:912 SESSIONS LN
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2962
Mailing Address - Country:US
Mailing Address - Phone:336-457-4153
Mailing Address - Fax:
Practice Address - Street 1:912 SESSIONS LN
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2962
Practice Address - Country:US
Practice Address - Phone:336-457-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities