Provider Demographics
NPI:1679709935
Name:LENTZ, AMY M (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:LENTZ
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4354 FOXFIRE TRL
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-9539
Mailing Address - Country:US
Mailing Address - Phone:616-490-8205
Mailing Address - Fax:
Practice Address - Street 1:4354 FOXFIRE TRL
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-9539
Practice Address - Country:US
Practice Address - Phone:616-490-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010867541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical