Provider Demographics
NPI:1124820667
Name:FLUCK, AMANDA PAIGE (MS, LMHCA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PAIGE
Last Name:FLUCK
Suffix:
Gender:
Credentials:MS, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 PLATEAU PT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-3556
Mailing Address - Country:US
Mailing Address - Phone:765-252-8179
Mailing Address - Fax:
Practice Address - Street 1:1400 AIRPORT NORTH OFFICE PARK STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6723
Practice Address - Country:US
Practice Address - Phone:260-702-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88002020A101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health