Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003316829 |
---|---|
Provider Name | Jennifer Lutz |
First Address | Taylorsville, UT 84123-5220 |
Second Address | Taylorsville, UT 84123-5220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2018 |
Last Update Date | 19/02/2018 |