Provider Demographics
NPI:1255168712
Name:LANTZ, AMANDA GRACE (LLMSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRACE
Last Name:LANTZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 W 8TH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-2708
Mailing Address - Country:US
Mailing Address - Phone:616-805-0953
Mailing Address - Fax:
Practice Address - Street 1:503 CENTURY LN STE 1
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4318
Practice Address - Country:US
Practice Address - Phone:616-795-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511187401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical