Provider Demographics
NPI:1043541675
Name:FICEK-LUEBKE, DANIELLE ROSE (MED, LPC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ROSE
Last Name:FICEK-LUEBKE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 19TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3222
Mailing Address - Country:US
Mailing Address - Phone:701-200-1230
Mailing Address - Fax:
Practice Address - Street 1:1827 19TH ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3222
Practice Address - Country:US
Practice Address - Phone:701-200-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND645-11-1-09101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional