MEDICARE: DELAINA KATHLEEN LANTZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	121997258	TN

General Provider Information

NPI Number	:	1033464730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELAINA KATHLEEN LANTZ

Provider Business Mailing Address
First Line	:	333 MURFREESBORO ROAD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-5321
Country	:	US
Telephone Number	:	219-393-0701
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 MURFREESBORO PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-2834
Country	:	US
Telephone Number	:	219-393-0701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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