Provider Demographics
NPI:1841939444
Name:NELLE STEPHAN-LUTZ, EDS, LMFT, LMHC
Entity type:Organization
Organization Name:NELLE STEPHAN-LUTZ, EDS, LMFT, LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHAN-LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-378-7526
Mailing Address - Street 1:2630 NW 41ST ST STE D3
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6666
Mailing Address - Country:US
Mailing Address - Phone:352-378-7526
Mailing Address - Fax:
Practice Address - Street 1:2630 NW 41ST ST STE D3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6666
Practice Address - Country:US
Practice Address - Phone:352-378-7526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty