Basic Information
| Provider Information | |||||||||
| NPI: | 1710423504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMBERTH | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S., MFTI #92984 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1881 BUSINESS CENTER DR | ||||||||
| Address2: | SUITE 10-A | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098902381 | ||||||||
| FaxNumber: | 9098900580 | ||||||||
| Practice Location | |||||||||
| Address1: | 1881 BUSINESS CENTER DR | ||||||||
| Address2: | SUITE 10-A | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098902381 | ||||||||
| FaxNumber: | 9098900580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2017 | ||||||||
| LastUpdateDate: | 01/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 92984 | CA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 92984 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP1600X | 92984 | CA | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 101YP2500X | 92984 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 92984 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106S00000X | 92984 | CA | N |
No ID Information.