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General NPI Number Information
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NPI Number | 1356853402
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Entity Type | Individual
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Provider Name | MICHAEL QUINN LONTZ
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Gender | Male
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 1150 BROADVIEW CT
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City | RENO
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State | NV
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Zip | 89521-4137
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Country | US
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Telephone | 907-617-7519
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18504
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City | RENO
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State | NV
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Zip | 89511-0504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 350
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License Number State | AK
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