MEDICARE: HEATHER MENTZER LBS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1790388429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MENTZER LBS

Provider Business Mailing Address
First Line	:	4606 N CLEARVIEW DR
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-4012
Country	:	US
Telephone Number	:	717-503-0531
Fax Number	:

Provider Business Practice Location Address
First Line	:	4606 N CLEARVIEW DR
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-4012
Country	:	US
Telephone Number	:	717-503-0531
Fax Number	:

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

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	12/02/2021

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Directions to “ HEATHER MENTZER LBS” Practice Location

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