Individual
MRS. DELISSA LEANN JANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
604 CHOCTAW ST, ALVA, OK 73717-1626
(580) 327-1112
Mailing address
1425 N MAIN ST STE 1, FAIRVIEW, OK 73737-2703
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11742
OK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/27/2020
Last updated
10/10/2023
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