Provider Demographics
NPI:1851158091
Name:BAKER-VANDE BRAKE, AMANDA RAE (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:BAKER-VANDE BRAKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-2029
Mailing Address - Country:US
Mailing Address - Phone:949-923-0516
Mailing Address - Fax:
Practice Address - Street 1:950 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-2029
Practice Address - Country:US
Practice Address - Phone:949-923-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist