Provider Demographics
NPI:1104312917
Name:WENTWOORD, ILKE-VANESSA MIU-LING (LMFT CA #138767)
Entity type:Individual
Prefix:
First Name:ILKE-VANESSA
Middle Name:MIU-LING
Last Name:WENTWOORD
Suffix:
Gender:F
Credentials:LMFT CA #138767
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S PALM CANYON DR STE 7-268
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-7213
Mailing Address - Country:US
Mailing Address - Phone:760-408-6807
Mailing Address - Fax:
Practice Address - Street 1:611 S PALM CANYON DR STE 7-268
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-7213
Practice Address - Country:US
Practice Address - Phone:760-408-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138767106H00000X
CA104199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist