Provider Demographics
NPI:1447323464
Name:LANZ, MELISSA (MA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LANZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 BEECH HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-4300
Mailing Address - Country:US
Mailing Address - Phone:603-726-0305
Mailing Address - Fax:
Practice Address - Street 1:6 CHENELL DR STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8514
Practice Address - Country:US
Practice Address - Phone:603-545-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706646Y0NH01OtherANTHEM