Basic Information
| Provider Information | |||||||||
| NPI: | 1336691849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LENZ | ||||||||
| FirstName: | CHRISTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9251 EAGLE RANCH RD NW | ||||||||
| Address2: | APT. 2221 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871146041 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2469 CORRALES RD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CORRALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870489146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058301871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2016 | ||||||||
| LastUpdateDate: | 10/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | X-09855 | NM | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.