Individual
CARLY LANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
313 S 3RD ST, GOSHEN, IN 46526-3709
(574) 538-7960
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
34008818A
IN
Other
Enumeration date
12/11/2017
Last updated
10/04/2022
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