Provider Demographics
NPI:1194095323
Name:GRENTZ, JANICE R (LPCC, NCC, CSAT)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:R
Last Name:GRENTZ
Suffix:
Gender:F
Credentials:LPCC, NCC, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2197 PINE HILL BROCK RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8502
Mailing Address - Country:US
Mailing Address - Phone:606-877-1840
Mailing Address - Fax:606-877-1840
Practice Address - Street 1:2197 PINE HILL BROCK RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8502
Practice Address - Country:US
Practice Address - Phone:606-877-1840
Practice Address - Fax:606-877-1840
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE