Healthcare Provider Details

I. General information

NPI: 1821634460
Provider Name (Legal Business Name): CPD3, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 N WHEELING AVE
MUNCIE IN
47303-1602
US

IV. Provider business mailing address

2205 N WHEELING AVE
MUNCIE IN
47303-1602
US

V. Phone/Fax

Practice location:
  • Phone: 765-287-1922
  • Fax: 765-287-9017
Mailing address:
  • Phone: 765-287-1922
  • Fax: 765-287-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TAMMY LAMPKE
Title or Position: OWNER/MANAGER
Credential:
Phone: 765-287-1922