Provider Demographics
NPI:1164679197
Name:PENTZ, WILLIAM K (LADC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
Last Name:PENTZ
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25098 181ST AVE
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-4852
Mailing Address - Country:US
Mailing Address - Phone:320-732-3287
Mailing Address - Fax:
Practice Address - Street 1:217 N UNION AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2127
Practice Address - Country:US
Practice Address - Phone:218-739-9084
Practice Address - Fax:218-739-0518
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)