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General NPI Number Information
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NPI Number | 1104312917
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Entity Type | Individual
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Provider Name | ILKE-VANESSA MIU-LING WENTWOORD LMFT CA #138767
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Gender | Female
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Dates
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Enumeration Date | 07/04/2018
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 611 S PALM CANYON DR STE 7-268
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City | PALM SPRINGS
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State | CA
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Zip | 92264-7213
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Country | US
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Telephone | 760-408-6807
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Fax |
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Provider Business Mailing Address
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Address Line | 611 S PALM CANYON DR STE 7-268
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City | PALM SPRINGS
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State | CA
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Zip | 92264-7213
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Country | US
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Telephone | 760-408-6807
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 138767
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 104199
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License Number State | CA
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