Provider Demographics
NPI:1457486789
Name:JOSEPH W LENZ PHD, PS
Entity Type:Organization
Organization Name:JOSEPH W LENZ PHD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-714-0830
Mailing Address - Street 1:PO BOX 1719
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1719
Mailing Address - Country:US
Mailing Address - Phone:808-232-9515
Mailing Address - Fax:335-205-0138
Practice Address - Street 1:2086 LILIKOI RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5043
Practice Address - Country:US
Practice Address - Phone:808-232-9515
Practice Address - Fax:833-520-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002351261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ25801Medicare UPIN
8807997Medicare ID - Type Unspecified