Healthcare Provider Details

I. General information

NPI: 1639087869
Provider Name (Legal Business Name): VICTOR EMANUEL LENNARTZ LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 E TANQUE VERDE RD STE 210
TUCSON AZ
85715-3859
US

IV. Provider business mailing address

4277 N RIVER GROVE CIR APT 120
TUCSON AZ
85719-1160
US

V. Phone/Fax

Practice location:
  • Phone: 520-423-5600
  • Fax:
Mailing address:
  • Phone: 520-505-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23520
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: