Provider Demographics
NPI:1649819145
Name:LUTZ, ELLEN J (LPC)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:J
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:J
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2406 E BONA AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-3657
Mailing Address - Country:US
Mailing Address - Phone:920-809-6766
Mailing Address - Fax:920-358-7535
Practice Address - Street 1:2031 E CALUMET ST.
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4742
Practice Address - Country:US
Practice Address - Phone:920-809-6766
Practice Address - Fax:920-358-7535
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health