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General NPI Number Information
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NPI Number | 1124820667
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Entity Type | Individual
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Provider Name | AMANDA PAIGE FLUCK MS, LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1400 AIRPORT NORTH OFFICE PARK STE D
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City | FORT WAYNE
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State | IN
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Zip | 46825-6723
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Country | US
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Telephone | 260-702-9141
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Fax |
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Provider Business Mailing Address
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Address Line | 2340 PLATEAU PT
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City | FORT WAYNE
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State | IN
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Zip | 46808-3556
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Country | US
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Telephone | 765-252-8179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88002020A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39005731A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 88002020A
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License Number State | IN
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