Provider Demographics
NPI:1528406071
Name:LENZ, BETH A (MED, LPC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:LENZ
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 SUGARLAND DR STE 152
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5720
Mailing Address - Country:US
Mailing Address - Phone:307-359-3340
Mailing Address - Fax:
Practice Address - Street 1:1949 SUGARLAND DR STE 152
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5720
Practice Address - Country:US
Practice Address - Phone:307-672-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
WYLPC-1614101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1528406071Medicaid