Provider Demographics
NPI:1992896997
Name:LENARZ, IVY (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:IVY
Middle Name:
Last Name:LENARZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-1359
Mailing Address - Country:US
Mailing Address - Phone:417-683-5739
Mailing Address - Fax:417-683-1602
Practice Address - Street 1:504 NW 10TH AVE.
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-1359
Practice Address - Country:US
Practice Address - Phone:417-683-5739
Practice Address - Fax:417-683-1602
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100011741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical