Healthcare Provider Details

I. General information

NPI: 1134518277
Provider Name (Legal Business Name): WAYNE LENZ MFT, FAMILY THERAPIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 S HARBOR BLVD STE 14
LA HABRA CA
90631-7570
US

IV. Provider business mailing address

1480 S HARBOR BLVD STE 14
LA HABRA CA
90631-7570
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-8782
  • Fax: 714-447-9386
Mailing address:
  • Phone:
  • Fax: 714-447-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35899
License Number StateCA

VIII. Authorized Official

Name: WAYNE LENZ
Title or Position: PRESIDENT
Credential:
Phone: 714-447-8782