Provider Demographics
NPI:1275654915
Name:LENTZ, CHARLIE (MS)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:LENTZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 JAMES AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1137
Mailing Address - Country:US
Mailing Address - Phone:612-752-8206
Mailing Address - Fax:612-752-8201
Practice Address - Street 1:1825 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1939
Practice Address - Country:US
Practice Address - Phone:612-752-8206
Practice Address - Fax:612-752-8201
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor