Provider Demographics
NPI:1669715215
Name:WENTWORTH-PUENTES, AMANDA LYNE (TMHC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNE
Last Name:WENTWORTH-PUENTES
Suffix:
Gender:F
Credentials:TMHC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNE
Other - Last Name:WENTWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC, MA
Mailing Address - Street 1:3125 DOUGLAS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3125 DOUGLAS AVE STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5310
Practice Address - Country:US
Practice Address - Phone:515-256-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health