Provider Demographics
NPI:1083164321
Name:LENTZ, PHILLIP (LMHC, SUDPT, MA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:LENTZ
Suffix:
Gender:M
Credentials:LMHC, SUDPT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31446
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-1446
Mailing Address - Country:US
Mailing Address - Phone:206-659-8376
Mailing Address - Fax:
Practice Address - Street 1:1600 2ND AVE APT 3605
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3350
Practice Address - Country:US
Practice Address - Phone:206-659-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61050032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health