Healthcare Provider Details

I. General information

NPI: 1003116393
Provider Name (Legal Business Name): LANCE P ARMSTRONG CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 JEFFERSON ST S
SHAKOPEE MN
55379-2051
US

IV. Provider business mailing address

1174 JEFFERSON ST S
SHAKOPEE MN
55379-2051
US

V. Phone/Fax

Practice location:
  • Phone: 612-364-3160
  • Fax:
Mailing address:
  • Phone: 612-364-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15521
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC01038
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: