1144301516 NPI number — MRS. CAROLE LELAND LUTNESS LCSW LAADC

Table of content: MRS. CAROLE LELAND LUTNESS LCSW LAADC (NPI 1144301516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144301516 NPI number — MRS. CAROLE LELAND LUTNESS LCSW LAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUTNESS
Provider First Name:
CAROLE
Provider Middle Name:
LELAND
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW LAADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144301516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25439 VIA MACARENA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-755-7524
Provider Business Mailing Address Fax Number:
661-799-3632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23560 PEACHLAND AVE #204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-755-7524
Provider Business Practice Location Address Fax Number:
661-799-3632
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 18703 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5895939 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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