Provider Demographics
NPI:1205286333
Name:STRUCK, AMANDA (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:STRUCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PELZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2855 TELEGRAPH AVE STE 515
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36100 GENESEE LAKE RD
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-9201
Practice Address - Country:US
Practice Address - Phone:262-490-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6006-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional