Provider Demographics
NPI:1528124997
Name:JENNINGS, AMANDA FARRELL (MFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:FARRELL
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21200 OXNARD ST # 907
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-5014
Mailing Address - Country:US
Mailing Address - Phone:805-497-0077
Mailing Address - Fax:
Practice Address - Street 1:4050 E THOUSAND OAKS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3655
Practice Address - Country:US
Practice Address - Phone:805-497-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43669106H00000X
CAMFT43669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist