Provider Demographics
NPI:1568806123
Name:PENTZ, KATHERINE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:PENTZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 PEPPERGRASS LN
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5585
Mailing Address - Country:US
Mailing Address - Phone:928-288-0565
Mailing Address - Fax:
Practice Address - Street 1:2681 PEPPERGRASS LN
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5585
Practice Address - Country:US
Practice Address - Phone:928-288-0565
Practice Address - Fax:928-854-1661
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-158411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ18933Medicare PIN