Provider Demographics
NPI:1073021747
Name:LENNICK, LANCE CHRISTOPHER (LPC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:CHRISTOPHER
Last Name:LENNICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 BROOKEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-7000
Mailing Address - Country:US
Mailing Address - Phone:406-471-3430
Mailing Address - Fax:
Practice Address - Street 1:1228 BROOKEN HILL DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-7000
Practice Address - Country:US
Practice Address - Phone:406-471-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health