Provider Demographics
NPI:1831385822
Name:KANTZ, WILL T (LPC RSOTP)
Entity type:Individual
Prefix:MR
First Name:WILL
Middle Name:T
Last Name:KANTZ
Suffix:
Gender:M
Credentials:LPC RSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3863 SW LOOP 820 STE 124
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-2064
Mailing Address - Country:US
Mailing Address - Phone:682-597-4312
Mailing Address - Fax:806-498-7510
Practice Address - Street 1:3863 SW LOOP 820 STE 124
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-2064
Practice Address - Country:US
Practice Address - Phone:682-597-4312
Practice Address - Fax:806-498-7510
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional