Provider Demographics
NPI:1437799251
Name:LONTZ-SMITH, CHANDRA RAE (LPC)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:RAE
Last Name:LONTZ-SMITH
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 1:16 MOUNTAIN VIEW AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3420
Mailing Address - Country:US
Mailing Address - Phone:970-815-1366
Mailing Address - Fax:
Practice Address - Street 1:16 MOUNTAIN VIEW AVE STE 112
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3420
Practice Address - Country:US
Practice Address - Phone:970-815-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional