Provider Demographics
NPI:1891076212
Name:LENZI, JASON P (MA LCPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:P
Last Name:LENZI
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ATKINSON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7817
Mailing Address - Country:US
Mailing Address - Phone:847-548-9425
Mailing Address - Fax:847-548-9404
Practice Address - Street 1:100 S ATKINSON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7817
Practice Address - Country:US
Practice Address - Phone:847-548-9425
Practice Address - Fax:847-548-9404
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional