Healthcare Provider Details

I. General information

NPI: 1922810399
Provider Name (Legal Business Name): TIFFANY SUE LAMBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3078 3RD ST
CLEARLAKE CA
95422-9603
US

IV. Provider business mailing address

PO BOX 1982
CLEARLAKE CA
95422-1981
US

V. Phone/Fax

Practice location:
  • Phone: 707-295-2252
  • Fax:
Mailing address:
  • Phone: 707-295-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: