Basic Information
Provider Information
NPI: 1003116393
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARMSTRONG
FirstName: LANCE
MiddleName: P
NamePrefix:  
NameSuffix:  
Credential: CSAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7974 UW HEALTH COURT
Address2:  
City: MIDDLETON
State: WI
PostalCode: 535625531
CountryCode: US
TelephoneNumber: 6088295485
FaxNumber:  
Practice Location
Address1: 25 KESSEL CT
Address2: STE 200
City: MADISON
State: WI
PostalCode: 537116227
CountryCode: US
TelephoneNumber: 6082788200
FaxNumber: 6082788204
Other Information
ProviderEnumerationDate: 11/02/2010
LastUpdateDate: 12/07/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400X15521WIY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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