Provider Demographics
NPI:1952791360
Name:LAMPRICH, MARK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:LAMPRICH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 ADDISON AVE W
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5851
Mailing Address - Country:US
Mailing Address - Phone:208-733-1624
Mailing Address - Fax:208-441-8637
Practice Address - Street 1:650 ADDISON AVE W
Practice Address - Street 2:SUITE 400
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5851
Practice Address - Country:US
Practice Address - Phone:208-733-1624
Practice Address - Fax:208-441-8637
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 343801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical