=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679739676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. LINDA K. LENTZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2008
-----------------------------------------------------
Last Update Date | 07/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7241 MOUNTAIN TRL
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-3151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-433-7044
-----------------------------------------------------
Fax | 937-433-4211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7241 MOUNTAIN TRL
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-3151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-433-7044
-----------------------------------------------------
Fax | 937-433-4211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | C0001048
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | SP412
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------