Provider Demographics
NPI:1356463590
Name:JANTZ, MELISSA (LMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JANTZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 GAR HWY
Mailing Address - Street 2:STE 4
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4224
Mailing Address - Country:US
Mailing Address - Phone:508-536-8088
Mailing Address - Fax:408-448-5617
Practice Address - Street 1:1162 GAR HWY
Practice Address - Street 2:STE 4
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4224
Practice Address - Country:US
Practice Address - Phone:508-536-8088
Practice Address - Fax:408-448-5617
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health