Provider Demographics
NPI:1679739676
Name:LENTZ, LINDA K
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:K
Last Name:LENTZ
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 1:7241 MOUNTAIN TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3151
Mailing Address - Country:US
Mailing Address - Phone:937-433-7044
Mailing Address - Fax:937-433-4211
Practice Address - Street 1:7241 MOUNTAIN TRL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3151
Practice Address - Country:US
Practice Address - Phone:937-433-7044
Practice Address - Fax:937-433-4211
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0001048101Y00000X
OHSP412103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor