Provider Demographics
NPI:1144753724
Name:VAN KALSBEEK, AMANDA (MS,LPCMH,LIMHP,LMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VAN KALSBEEK
Suffix:
Gender:F
Credentials:MS,LPCMH,LIMHP,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N CLIFF AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032-2524
Mailing Address - Country:US
Mailing Address - Phone:605-610-9094
Mailing Address - Fax:
Practice Address - Street 1:225 N CLIFF AVE STE 4
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-2524
Practice Address - Country:US
Practice Address - Phone:605-610-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2482101YP2500X, 101YM0800X
IA085417101YP2500X
SD30937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027572600Medicaid
NE1639562069OtherGROUP NPI FOR HEARTLAND FAMILY SERVICE CENTERAL