Provider Demographics
NPI:1083336424
Name:AMANDA STIENSTRA LMSW LLC
Entity Type:Organization
Organization Name:AMANDA STIENSTRA LMSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STIENSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-885-2676
Mailing Address - Street 1:7210 COCONUT DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8722
Mailing Address - Country:US
Mailing Address - Phone:616-885-2676
Mailing Address - Fax:
Practice Address - Street 1:2874 PORT SHELDON ST STE E
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-7898
Practice Address - Country:US
Practice Address - Phone:616-379-9845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty