Provider Demographics
NPI:1447940440
Name:KIENTZLE, LUKE
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:
Last Name:KIENTZLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 JASON DR
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-5108
Mailing Address - Country:US
Mailing Address - Phone:972-268-2521
Mailing Address - Fax:
Practice Address - Street 1:618 CLARA BARTON BLVD STE 7
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5731
Practice Address - Country:US
Practice Address - Phone:972-268-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor