Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003273871 |
---|---|
Provider Name | Mallory Rose Lutes |
First Address | Owensboro, KY 42301-2956 |
Second Address | Owensboro, KY 42301-2956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2016 |
Last Update Date | 25/01/2016 |