MEDICARE: ANTHONY J DAEMKE MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT.0001685	CO

General Provider Information

NPI Number	:	1386299592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J DAEMKE MA, LMFT

Provider Business Mailing Address
First Line	:	5745 E OLD FARM CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1141
Country	:	US
Telephone Number	:	719-659-5329
Fax Number	:

Provider Business Practice Location Address
First Line	:	5745 E OLD FARM CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1141
Country	:	US
Telephone Number	:	719-659-5329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	12/04/2023

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