Provider Demographics
NPI:1972760445
Name:QUALMANN, LANCE EDWIN (MA, QHMP)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:EDWIN
Last Name:QUALMANN
Suffix:
Gender:M
Credentials:MA, QHMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7414 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2220
Mailing Address - Country:US
Mailing Address - Phone:314-565-8009
Mailing Address - Fax:
Practice Address - Street 1:988 N ILLINOIS ROUTE 3
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1000
Practice Address - Country:US
Practice Address - Phone:618-939-4444
Practice Address - Fax:618-939-4181
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor