Provider Demographics
NPI:1194173203
Name:NANTZ, SANDRA J (PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:NANTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 MEADOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKHOLDS
Mailing Address - State:KY
Mailing Address - Zip Code:40759-9564
Mailing Address - Country:US
Mailing Address - Phone:606-261-7622
Mailing Address - Fax:606-261-7312
Practice Address - Street 1:1776 MEADOW CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKHOLDS
Practice Address - State:KY
Practice Address - Zip Code:40759-9564
Practice Address - Country:US
Practice Address - Phone:606-261-7622
Practice Address - Fax:606-261-7312
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY262165103T00000X, 103TC1900X, 103TC2200X, 103TF0000X, 103TP2701X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy