NPI 1164860052

Jacob Thomas Lutz, PHD

Practitioner Clinical Neuropsychologist Fort Wayne, IN

Practice location

Address: 11104 Parkview Circle Dr STE 110, Fort Wayne, IN 46845-1673
Phone: (260) 460-3203
Fax: (260) 460-3271

Registered specialties

Clinical Neuropsychologist Primary

Behavioral Health & Social Service Providers Taxonomy 103G00000X Licence 20042679A (IN)

Other Clinical Neuropsychologist providers in Indiana →

Registry record

NPI: 1164860052
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Jun 2013
Record last updated: 13 Jun 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.