Healthcare Provider Details

I. General information

NPI: 1154152783
Provider Name (Legal Business Name): STEPHEN LAMBERJACK LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11371 CORTEZ BLVD STE 210
BROOKSVILLE FL
34613-5410
US

IV. Provider business mailing address

7217 ROYAL OAK DR
SPRING HILL FL
34607-2335
US

V. Phone/Fax

Practice location:
  • Phone: 352-616-7600
  • Fax:
Mailing address:
  • Phone: 727-272-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: