Provider Demographics
NPI:1700075785
Name:LENZ, ANNEVA ELLEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNEVA
Middle Name:ELLEN
Last Name:LENZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 N FIVE MILE RD
Mailing Address - Street 2:STE. A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5215
Mailing Address - Country:US
Mailing Address - Phone:208-376-4999
Mailing Address - Fax:208-323-9349
Practice Address - Street 1:3098 N FIVE MILE RD
Practice Address - Street 2:STE. A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5215
Practice Address - Country:US
Practice Address - Phone:208-376-4999
Practice Address - Fax:208-323-9349
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW3001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical