Provider Demographics
NPI:1285419986
Name:LUTZ, TANYA MARIE (PLMHP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 PENN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:69022-3500
Mailing Address - Country:US
Mailing Address - Phone:308-350-0860
Mailing Address - Fax:
Practice Address - Street 1:1301 E H ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3482
Practice Address - Country:US
Practice Address - Phone:308-344-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)