Provider Demographics
NPI:1184158982
Name:LENTZ, KARISSA (PSYD, LMFT)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:LENTZ
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 VISTA RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1184
Mailing Address - Country:US
Mailing Address - Phone:619-685-9769
Mailing Address - Fax:
Practice Address - Street 1:2260 VISTA RIDGE CIR
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1184
Practice Address - Country:US
Practice Address - Phone:619-685-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86987106H00000X
CA34905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist