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WENTWORTH MFT PLLC

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Company Details

Legal Name: WENTWORTH MFT PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: April 24th 2020
Expiration date: 30 Apr 2026
UBI Number: 604 609 631
ZIP code: 98597
City: Yelm
County: THURSTON
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 313 YELM AVE W, YELM, WA, 98597-8036, UNITED STATES

Contact Details

E-Mail: JENNIFER@WENTWORTHMFT.COM
Phone Number: +1 360-960-0441

Nature of Business

Health Care, Social Assistance & Service Organization, MARRIAGE AND FAMILY THERAPIST AND CHEMICAL DEPENDENCY PROFESSIONAL

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Registered Agent Information

Name Role Address
JENNIFER WENTWORTH Registered Agent 706 GROVE LN, RAINIER, WA, 98576-6300, UNITED STATES

Key Officers & Management

Name Role Address
SHELLY POTTER Executor 1201 PACIFIC AVE STE 2100, TACOMA, WA, 98402-4314, UNITED STATES
JENNIFER WENTWORTH Governing Person -

National Provider Identifier

NPI Number:
1518674993
Certification Date:
2022-11-03

Authorized Person:

Name:
JENNIFER WENTWORTH
Role:
THERAPIST/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
No
Selected Taxonomy:
261QM0850X - Adult Mental Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QM0855X - Adolescent and Children Mental Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
Yes

Contacts:

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