Provider Demographics
NPI:1023744604
Name:LUTKUS, BRITTNEY RENA
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:RENA
Last Name:LUTKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 SHATTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2329
Mailing Address - Country:US
Mailing Address - Phone:989-752-7867
Mailing Address - Fax:
Practice Address - Street 1:508 SHATTUCK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2329
Practice Address - Country:US
Practice Address - Phone:989-752-7867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922249440Medicaid