Healthcare Provider Details

I. General information

NPI: 1053961615
Provider Name (Legal Business Name): BRANDY MICHELLE LAMB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 HILLVIEW RD
SANTA MARIA CA
93455-3213
US

IV. Provider business mailing address

116 AGNES AVE
SANTA MARIA CA
93458-2838
US

V. Phone/Fax

Practice location:
  • Phone: 805-219-9692
  • Fax:
Mailing address:
  • Phone: 805-457-3724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number123124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: