Provider Demographics
NPI:1477872844
Name:WIENS, AMANDA LEE (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:WIENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737
Mailing Address - Country:US
Mailing Address - Phone:405-664-7540
Mailing Address - Fax:580-701-2658
Practice Address - Street 1:1425 N MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737
Practice Address - Country:US
Practice Address - Phone:405-664-7540
Practice Address - Fax:580-701-2658
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3575101YM0800X
OKLPC03575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health