Provider Demographics
NPI:1821541913
Name:LUMPE, GUSTAV
Entity Type:Individual
Prefix:
First Name:GUSTAV
Middle Name:
Last Name:LUMPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SHELARD PKWY APT 200
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4909
Mailing Address - Country:US
Mailing Address - Phone:314-283-0480
Mailing Address - Fax:
Practice Address - Street 1:255 SHELARD PKWY APT 200
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4909
Practice Address - Country:US
Practice Address - Phone:314-283-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst