Healthcare Provider Details

I. General information

NPI: 1821053794
Provider Name (Legal Business Name): THOMAS CHARLES FLAMBOE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S MAIN ST SUITE 1E
ABERDEEN SD
57401-4189
US

IV. Provider business mailing address

14 S MAIN ST SUITE 1E
ABERDEEN SD
57401-4189
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-1010
  • Fax: 605-725-8055
Mailing address:
  • Phone: 605-225-1010
  • Fax: 605-725-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number684
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1021
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: