Provider Demographics
NPI:1902798002
Name:LORENTZ, JACKSON P (RMHCI)
Entity type:Individual
Prefix:MR
First Name:JACKSON
Middle Name:P
Last Name:LORENTZ
Suffix:
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1104
Mailing Address - Country:US
Mailing Address - Phone:954-654-0350
Mailing Address - Fax:
Practice Address - Street 1:550 SE 6TH AVE STE 200P2
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5306
Practice Address - Country:US
Practice Address - Phone:954-654-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health