Healthcare Provider Details

I. General information

NPI: 1710423504
Provider Name (Legal Business Name): SCOTT LAMBERTH M.S., MFTI #92984
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 BUSINESS CENTER DR SUITE 10-A
SAN BERNARDINO CA
92408-3465
US

IV. Provider business mailing address

1881 BUSINESS CENTER DR SUITE 10-A
SAN BERNARDINO CA
92408-3465
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-2381
  • Fax: 909-890-0580
Mailing address:
  • Phone: 909-890-2381
  • Fax: 909-890-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number92984
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number92984
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number92984
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92984
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92984
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number92984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: