Provider Demographics
NPI:1598728677
Name:HENTZ, LUANN KAY (MA, LP)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:KAY
Last Name:HENTZ
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 NORSE LN
Mailing Address - Street 2:04
Mailing Address - City:KEYSTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80435-7660
Mailing Address - Country:US
Mailing Address - Phone:970-333-0734
Mailing Address - Fax:
Practice Address - Street 1:120 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-333-0734
Practice Address - Fax:970-668-3389
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8F78HEOtherBLUECROSS/BLUESHIELD
MN745052400Medicaid
MNHP51217OtherHEALTHPARTNERS
MN928011033387OtherPREFERREDONE