Provider Demographics
NPI:1275428419
Name:KIRK-LUTCHER, CAMERON GREGORY (DSP)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:GREGORY
Last Name:KIRK-LUTCHER
Suffix:
Gender:M
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E INVERNESS AVE APT 1022
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6972
Mailing Address - Country:US
Mailing Address - Phone:541-650-2464
Mailing Address - Fax:
Practice Address - Street 1:2020 E INVERNESS AVE APT 1022
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6972
Practice Address - Country:US
Practice Address - Phone:541-650-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251C00000X, 372500000X, 372600000X, 373H00000X, 3747P1801X, 376J00000X, 385H00000X, 385HR2055X, 385HR2065X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child