Provider Demographics
NPI:1568677664
Name:BANKEN, AMBER MALESCHA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MALESCHA
Last Name:BANKEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:MALESCHA
Other - Last Name:DEROUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4757 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4740
Mailing Address - Country:US
Mailing Address - Phone:409-963-2331
Mailing Address - Fax:
Practice Address - Street 1:4757 MAIN AVE
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4740
Practice Address - Country:US
Practice Address - Phone:409-963-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health