Healthcare Provider Details

I. General information

NPI: 1326475229
Provider Name (Legal Business Name): NATHAN LENZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 ANDERSON AVE STE 101
MANHATTAN KS
66502-3027
US

IV. Provider business mailing address

2505 ANDERSON AVE STE 101
MANHATTAN KS
66502-3027
US

V. Phone/Fax

Practice location:
  • Phone: 785-236-0068
  • Fax: 785-789-4048
Mailing address:
  • Phone: 785-236-0068
  • Fax: 785-789-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number852
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number852
License Number StateKS

VIII. Authorized Official

Name: NATHANAEL M LENZ
Title or Position: SOLE PROPRIETOR
Credential: LMFT
Phone: 785-317-0908