Provider Demographics
NPI:1972707966
Name:BENTANCOURT, AMY JEAN (MFT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JEAN
Last Name:BENTANCOURT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:JEAN
Other - Last Name:HARBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1683
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-3683
Mailing Address - Country:US
Mailing Address - Phone:925-325-7045
Mailing Address - Fax:925-684-7737
Practice Address - Street 1:815 1ST ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1177
Practice Address - Country:US
Practice Address - Phone:925-325-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist