Provider Demographics
NPI:1003577412
Name:WENDLE, AMANDA LYN (LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYN
Last Name:WENDLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 COPPERSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-8605
Mailing Address - Country:US
Mailing Address - Phone:863-614-8330
Mailing Address - Fax:
Practice Address - Street 1:1801 CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5979
Practice Address - Country:US
Practice Address - Phone:863-709-8543
Practice Address - Fax:863-688-2520
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional