Provider Demographics
NPI:1801435581
Name:NANTZ, EMILY CLAIRE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CLAIRE
Last Name:NANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-0321
Mailing Address - Country:US
Mailing Address - Phone:606-909-2220
Mailing Address - Fax:
Practice Address - Street 1:104 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1912
Practice Address - Country:US
Practice Address - Phone:859-385-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health