Provider Demographics
NPI:1063808590
Name:LUTTRELL, MICHELLE (LMFT-A, LCDC-I)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:LMFT-A, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WHITTIER CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7023
Mailing Address - Country:US
Mailing Address - Phone:940-453-4757
Mailing Address - Fax:
Practice Address - Street 1:5 WHITTIER CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7023
Practice Address - Country:US
Practice Address - Phone:940-453-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist