Individual
AMANDA LEE WIENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1425 N MAIN ST, STE 2, FAIRVIEW, OK 73737
(405) 664-7540
(580) 701-2658
Mailing address
PO BOX 265, FAIRVIEW, OK 73737
(405) 664-7540
(580) 701-2658
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
3575
OK
101YM0800X
Mental Health Counselor
Primary
LPC03575
OK
Other
Enumeration date
05/25/2010
Last updated
10/25/2023
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