Provider Demographics
NPI:1912606120
Name:LUTTRELL, COREY C (LMSW)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:C
Last Name:LUTTRELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 POWERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2972
Mailing Address - Country:US
Mailing Address - Phone:225-270-2309
Mailing Address - Fax:
Practice Address - Street 1:2163 POWERBROOK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2972
Practice Address - Country:US
Practice Address - Phone:225-270-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA158121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical