Provider Demographics
NPI:1346802873
Name:LANTZ, RONDA (LPC)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:LANTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 E FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5421
Mailing Address - Country:US
Mailing Address - Phone:480-352-5740
Mailing Address - Fax:
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 123
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4263
Practice Address - Country:US
Practice Address - Phone:480-818-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18979101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional