Provider Demographics
NPI:1679856686
Name:LENVIN, AMANDA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:LENVIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W WEBSTER AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2927
Mailing Address - Country:US
Mailing Address - Phone:312-772-6124
Mailing Address - Fax:
Practice Address - Street 1:1820 W WEBSTER AVE STE 450
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2927
Practice Address - Country:US
Practice Address - Phone:312-772-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010683101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor