Provider Demographics
NPI:1154676864
Name:LENZ, SANDRA (LMSW MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LENZ
Suffix:
Gender:F
Credentials:LMSW MSW
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:LENZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW MSW
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-1910
Mailing Address - Country:US
Mailing Address - Phone:417-894-5178
Mailing Address - Fax:
Practice Address - Street 1:4602 N QUAIL RUN RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-6246
Practice Address - Country:US
Practice Address - Phone:417-894-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012018364104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker