Provider Demographics
NPI:1104023878
Name:LENTZ, CHARLES (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:LENTZ
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 FOURMILE PKWY
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9114
Mailing Address - Country:US
Mailing Address - Phone:719-276-7500
Mailing Address - Fax:719-276-6961
Practice Address - Street 1:700 FOURMILE PKWY
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9114
Practice Address - Country:US
Practice Address - Phone:719-276-7500
Practice Address - Fax:719-276-6961
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72406259Medicaid