Provider Demographics
NPI:1225345937
Name:BAKKE, ETHEL ANN (LPC, NCC, LMHC, CAP)
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:ANN
Last Name:BAKKE
Suffix:
Gender:F
Credentials:LPC, NCC, LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 LEWIS LN STE 101
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3755
Mailing Address - Country:US
Mailing Address - Phone:321-474-4661
Mailing Address - Fax:
Practice Address - Street 1:253 LEWIS LN STE 101
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3755
Practice Address - Country:US
Practice Address - Phone:321-474-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI90988101Y00000X
FLMH10373101YM0800X
MI6401009158101YM0800X
MDLC8445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor