Provider Demographics
NPI:1487194890
Name:LENTZ, JESSICA J (LPC, CRC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:J
Last Name:LENTZ
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8072 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4310
Mailing Address - Country:US
Mailing Address - Phone:586-932-2700
Mailing Address - Fax:586-932-2705
Practice Address - Street 1:8072 21 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-4310
Practice Address - Country:US
Practice Address - Phone:586-932-2700
Practice Address - Fax:586-932-2705
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015287101YP2500X
MI00216924101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional