Provider Demographics
NPI:1477648343
Name:LAMBERTZ, CHARLES PRACHT (LSCSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PRACHT
Last Name:LAMBERTZ
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 9TH SUITE A
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901
Mailing Address - Country:US
Mailing Address - Phone:785-262-3202
Mailing Address - Fax:785-262-3201
Practice Address - Street 1:210 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-5200
Practice Address - Country:US
Practice Address - Phone:785-243-8900
Practice Address - Fax:785-243-8933
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200436070BMedicaid
KS200436070BMedicaid