Provider Demographics
NPI:1811243728
Name:LAMP, CHARLES (LMFT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:LAMP
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 1:101 MAIN ST S STE 208
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-2564
Mailing Address - Country:US
Mailing Address - Phone:320-234-7100
Mailing Address - Fax:
Practice Address - Street 1:101 MAIN ST S STE 208
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2564
Practice Address - Country:US
Practice Address - Phone:320-234-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist