Healthcare Provider Details

I. General information

NPI: 1326825456
Provider Name (Legal Business Name): ANSON LAMPE LPCC, BC-DMT, GL-CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 ILLINOIS AVE
DAYTON OH
45410-2034
US

IV. Provider business mailing address

144 ILLINOIS AVE
DAYTON OH
45410-2034
US

V. Phone/Fax

Practice location:
  • Phone: 937-287-5673
  • Fax:
Mailing address:
  • Phone: 937-287-5673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberE.2001740
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberE.2001740
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: