Provider Demographics
NPI:1144661182
Name:STANTON, CHARLOTTE A (MS, LMHP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:A
Last Name:STANTON
Suffix:
Gender:F
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8536 GRANVILLE PKWY APT 836
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2465
Mailing Address - Country:US
Mailing Address - Phone:402-507-1029
Mailing Address - Fax:
Practice Address - Street 1:8536 GRANVILLE PKWY APT 836
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2465
Practice Address - Country:US
Practice Address - Phone:402-507-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4193101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist