Provider Demographics
NPI:1467762047
Name:CASS, CHARITY L (LMHC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:L
Last Name:CASS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:L
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:4656 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6857
Mailing Address - Country:US
Mailing Address - Phone:260-969-0915
Mailing Address - Fax:260-969-0917
Practice Address - Street 1:4656 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6857
Practice Address - Country:US
Practice Address - Phone:260-969-0915
Practice Address - Fax:260-969-0917
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002106A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health