Individual
MRS. JILL LUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LLP
Contact information
Practice address
363 W BIG BEAVER RD STE 200, TROY, MI 48084-5380
(248) 509-7657
(248) 509-7658
Mailing address
363 W BIG BEAVER RD STE 200, TROY, MI 48084-5380
(248) 509-7657
(248) 509-7658
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361004210
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6361004210
6361004210
MI
Enumeration date
12/08/2021
Last updated
12/08/2021
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