Healthcare Provider Details

I. General information

NPI: 1376463356
Provider Name (Legal Business Name): AMANDA K GUIDEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 W NORTH AVE STE 300
BROOKFIELD WI
53005-4479
US

IV. Provider business mailing address

17100 W NORTH AVE STE 300
BROOKFIELD WI
53005-4479
US

V. Phone/Fax

Practice location:
  • Phone: 262-244-6177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6652-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: