Provider Demographics
NPI:1912524893
Name:LUTHER, KYLA MARIE (CSAC, CS-IT)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:MARIE
Last Name:LUTHER
Suffix:
Gender:F
Credentials:CSAC, CS-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2358
Mailing Address - Country:US
Mailing Address - Phone:608-647-8821
Mailing Address - Fax:
Practice Address - Street 1:221 W SEMINARY ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2358
Practice Address - Country:US
Practice Address - Phone:608-647-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16320-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)