Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 103K00000X | Behavior Analyst |
NPI | 1003238155 |
---|---|
Provider Name | Henry Augustus Lutterodt |
First Address | Kenner, LA 70065-2962 |
Second Address | Kenner, LA 70065-2962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2014 |
Last Update Date | 08/01/2014 |