Provider Demographics
NPI:1770838997
Name:MANTZARIS, LEZLI (LMHP, LPC)
Entity Type:Individual
Prefix:
First Name:LEZLI
Middle Name:
Last Name:MANTZARIS
Suffix:
Gender:F
Credentials:LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S 258TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NE
Mailing Address - Zip Code:68069-4814
Mailing Address - Country:US
Mailing Address - Phone:402-881-7557
Mailing Address - Fax:
Practice Address - Street 1:1314 S 258TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NE
Practice Address - Zip Code:68069-4814
Practice Address - Country:US
Practice Address - Phone:402-881-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health