Provider Demographics
NPI:1386983708
Name:LUTZ, JUSTIN CHRISTOPHER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CHRISTOPHER
Last Name:LUTZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 THE CITY DRIVE
Mailing Address - Street 2:MOB44 2ND FLOOR
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:949-680-6791
Mailing Address - Fax:
Practice Address - Street 1:63 CARRIAGE HILL LN
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-6039
Practice Address - Country:US
Practice Address - Phone:949-680-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31972103T00000X
CAWAIVERED103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist