Provider Demographics
NPI:1346924685
Name:ADETUTU, BIANCA SIMONE REED (LMFT)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:SIMONE REED
Last Name:ADETUTU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6224
Mailing Address - Country:US
Mailing Address - Phone:430-322-8087
Mailing Address - Fax:
Practice Address - Street 1:3629 MCDONALD RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-6224
Practice Address - Country:US
Practice Address - Phone:430-322-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health