Provider Demographics
NPI:1801038989
Name:LAMPERT, JOHN MARSHALL (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARSHALL
Last Name:LAMPERT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1006
Mailing Address - Country:US
Mailing Address - Phone:612-676-1604
Mailing Address - Fax:612-379-8235
Practice Address - Street 1:2649 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1006
Practice Address - Country:US
Practice Address - Phone:612-676-1604
Practice Address - Fax:612-379-8235
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist