Healthcare Provider Details

I. General information

NPI: 1861157661
Provider Name (Legal Business Name): KARINA LANTZY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 VALLEY RD
CANON CITY CO
81212-4291
US

IV. Provider business mailing address

465 VALLEY RD
CANON CITY CO
81212-4291
US

V. Phone/Fax

Practice location:
  • Phone: 719-458-8050
  • Fax: 719-745-7656
Mailing address:
  • Phone: 719-458-8050
  • Fax: 719-745-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930083
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: