Provider Demographics
NPI:1922016427
Name:LOBAN, CHARLES (LP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:LOBAN
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 CENTRAL AVE NE
Mailing Address - Street 2:RISE , INCORPORATED
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4531
Mailing Address - Country:US
Mailing Address - Phone:612-706-2511
Mailing Address - Fax:612-781-1288
Practice Address - Street 1:2001 BLOOMINGTON AVE
Practice Address - Street 2:COMMUNITY UNIVERSITY HEALTH CARE CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3074
Practice Address - Country:US
Practice Address - Phone:612-638-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2880103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical