Healthcare Provider Details

I. General information

NPI: 1114127792
Provider Name (Legal Business Name): JANET KRANTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 ISSAQUEENA TRL APT 122
CENTRAL SC
29630-9373
US

IV. Provider business mailing address

843 ISSAQUEENA TRL APT 122
CENTRAL SC
29630-9373
US

V. Phone/Fax

Practice location:
  • Phone: 864-656-2451
  • Fax: 864-656-0760
Mailing address:
  • Phone: 864-656-2451
  • Fax: 864-656-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: