Provider Demographics
NPI:1346630985
Name:ETENGOFF, AMANDA (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ETENGOFF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5347 NW 122ND DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3630
Mailing Address - Country:US
Mailing Address - Phone:954-552-8997
Mailing Address - Fax:
Practice Address - Street 1:5347 NW 122ND DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3630
Practice Address - Country:US
Practice Address - Phone:954-552-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3493106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist