Provider Demographics
NPI:1407182868
Name:IENNI, AMY (LMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:IENNI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 E KERESAN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3830
Mailing Address - Country:US
Mailing Address - Phone:505-417-4568
Mailing Address - Fax:
Practice Address - Street 1:3858 E KERESAN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3830
Practice Address - Country:US
Practice Address - Phone:505-417-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0178241101YP2500X
AZLPC-20165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional