Healthcare Provider Details

I. General information

NPI: 1053225995
Provider Name (Legal Business Name): JEANINE JANTZ, LCPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N COLLEGE PARK ST STE 700
DERBY KS
67037-3666
US

IV. Provider business mailing address

1121 N COLLEGE PARK ST STE 700
DERBY KS
67037-3666
US

V. Phone/Fax

Practice location:
  • Phone: 316-243-8362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEANINE JANTZ
Title or Position: OWNER/PROVIDER
Credential: M.ED.
Phone: 316-243-8362