Basic Information
| Provider Information | |||||||||
| NPI: | 1922518315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENZE | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MA, NCC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 319 | ||||||||
| Address2: | |||||||||
| City: | BIGLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168250319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143425678 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 427 N SAINT MARYS ST | ||||||||
| Address2: | |||||||||
| City: | SAINT MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158573657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148349283 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | PC005581 | PA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | PC0005581 | PA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | PC005581 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.