Provider Demographics
NPI:1386299592
Name:DAEMKE, ANTHONY J (MA, LMFT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:DAEMKE
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 E OLD FARM CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1141
Mailing Address - Country:US
Mailing Address - Phone:719-659-5329
Mailing Address - Fax:
Practice Address - Street 1:5745 E OLD FARM CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-1141
Practice Address - Country:US
Practice Address - Phone:719-659-5329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist