Provider Demographics
NPI:1114594546
Name:VANDEN BROEKE, ANDREW (MA LAMFT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:VANDEN BROEKE
Suffix:
Gender:M
Credentials:MA LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 DEVONSHIRE CURV
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-5002
Mailing Address - Country:US
Mailing Address - Phone:303-803-2573
Mailing Address - Fax:
Practice Address - Street 1:1354 DEVONSHIRE CURV
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-5002
Practice Address - Country:US
Practice Address - Phone:303-803-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health