Provider Demographics
NPI:1235151648
Name:LENTZ, JAN L (LISW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:L
Last Name:LENTZ
Suffix:
Gender:F
Credentials:LISW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-5566
Mailing Address - Country:US
Mailing Address - Phone:432-263-7361
Mailing Address - Fax:432-268-5086
Practice Address - Street 1:300 W VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5566
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:432-268-5086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 397371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM 1-05086OtherLISW SOCIAL WORK LICENSE
TXTX 39737OtherLCSW LICENSE