Provider Demographics
NPI:1245505007
Name:BAKKE, CAROLE PETRIDES (MS, LIMHP, CPC)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:PETRIDES
Last Name:BAKKE
Suffix:
Gender:F
Credentials:MS, LIMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11912 ELM ST STE 120
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4386
Mailing Address - Country:US
Mailing Address - Phone:402-980-6648
Mailing Address - Fax:
Practice Address - Street 1:11912 ELM ST STE 120
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4386
Practice Address - Country:US
Practice Address - Phone:402-980-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health