Provider Demographics
NPI:1457974578
Name:LUTON, KELYN
Entity Type:Individual
Prefix:
First Name:KELYN
Middle Name:
Last Name:LUTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5287 MARIA CRISTINA CT
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-1572
Mailing Address - Country:US
Mailing Address - Phone:254-537-2875
Mailing Address - Fax:
Practice Address - Street 1:3436 ELOISE LN
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-1517
Practice Address - Country:US
Practice Address - Phone:254-537-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional