Healthcare Provider Details

I. General information

NPI: 1619705696
Provider Name (Legal Business Name): BRIAN MICHAEL LAMBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N PASS AVE STE 202
BURBANK CA
91505-3936
US

IV. Provider business mailing address

257 GOLDENWOOD CIR
SIMI VALLEY CA
93065-6772
US

V. Phone/Fax

Practice location:
  • Phone: 818-433-7831
  • Fax:
Mailing address:
  • Phone: 415-310-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: