Active NPI
Shannon Courtney Lutz, LPA
- Psychologist
- Charlotte, NC
National Provider Identifier
1316043128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2532
- Practice address
- 1515 Mockingbird LN
Suite 515
Charlotte, NC 28209-3236 - Phone
- (704) 999-4191
- Fax
- (980) 949-8180
- NPI assigned
- Sep 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2532 | NC | Primary |
Addresses
Primary practice location
1515 Mockingbird LN
Suite 515
Charlotte, NC 28209-3236
Mailing address
1515 Mockingbird LN
Suite 515
Charlotte, NC 28209-3236
Phone (704) 999-4191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107208 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2532 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357862400000",
"number": "1316043128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 MOCKINGBIRD LN",
"address_2": "SUITE 515",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282093236",
"telephone_number": "704-999-4191",
"fax_number": "980-949-8180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 MOCKINGBIRD LN",
"address_2": "SUITE 515",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282093236",
"telephone_number": "704-999-4191",
"fax_number": "980-949-8180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTZ",
"first_name": "SHANNON",
"middle_name": "COURTNEY",
"credential": "LPA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2013-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2532",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107208",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.