Provider Demographics
NPI:1457848640
Name:LENZ, GINA E (LPC-IT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:E
Last Name:LENZ
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:RUTZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6799
Mailing Address - Country:US
Mailing Address - Phone:715-848-4600
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE VIEW DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6799
Practice Address - Country:US
Practice Address - Phone:715-848-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional