Provider Demographics
NPI:1235703208
Name:KWENTUS, AMBER JO (LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JO
Last Name:KWENTUS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SAINT REGIS LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6749
Mailing Address - Country:US
Mailing Address - Phone:314-695-4746
Mailing Address - Fax:
Practice Address - Street 1:120 SAINT REGIS LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6749
Practice Address - Country:US
Practice Address - Phone:314-695-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019015463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional