Provider Demographics
NPI:1477639805
Name:LENTZ, MOLLIE CAMPBELL (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:CAMPBELL
Last Name:LENTZ
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 114TH AVE SE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-453-1311
Mailing Address - Fax:
Practice Address - Street 1:1309 114TH AVE SE
Practice Address - Street 2:SUITE 316
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6903
Practice Address - Country:US
Practice Address - Phone:425-453-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist