Provider Demographics
NPI:1225763451
Name:JENKS, AMANDA VAN LEEUWEN (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:VAN LEEUWEN
Last Name:JENKS
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:VAN LEEUWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:274 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3915
Mailing Address - Country:US
Mailing Address - Phone:435-213-9278
Mailing Address - Fax:
Practice Address - Street 1:1660 W ANTELOPE DR STE 301
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1156
Practice Address - Country:US
Practice Address - Phone:435-213-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist