Provider Demographics
NPI:1912179854
Name:JANTZ, DONNA JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:JANTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20066 FLINT LANE
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465
Mailing Address - Country:US
Mailing Address - Phone:720-351-0052
Mailing Address - Fax:303-979-7498
Practice Address - Street 1:20066 FLINT LN
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2401
Practice Address - Country:US
Practice Address - Phone:720-351-0052
Practice Address - Fax:303-979-7498
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health