Provider Demographics
NPI:1952931891
Name:LUTTRELL, THOMAS (PHD, LCMFT)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:LUTTRELL
Suffix:
Gender:M
Credentials:PHD, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 AVENTURINE WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5253
Mailing Address - Country:US
Mailing Address - Phone:909-907-2256
Mailing Address - Fax:
Practice Address - Street 1:7201 WISCONSIN AVE STE 440
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4851
Practice Address - Country:US
Practice Address - Phone:240-342-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT111604106H00000X
MDLCM754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist