MEDICARE: SHERRY A LANTZ MA., LPC

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	002068	PA

General Provider Information

NPI Number	:	1912238817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY A LANTZ MA., LPC

Provider Business Mailing Address
First Line	:	1 E MAIN ST
Second Line	:	SUITE # 221
City	:	NORTH EAST
State	:	PA
Zip	:	16428-1318
Country	:	US
Telephone Number	:	814-725-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E MAIN ST
Second Line	:	SUITE # 221
City	:	NORTH EAST
State	:	PA
Zip	:	16428-1318
Country	:	US
Telephone Number	:	814-725-3347
Fax Number	:

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

Provider Enumeration Date	:	01/18/2010
Last Update Date	:	01/18/2010

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