Healthcare Provider Details

I. General information

NPI: 1053038158
Provider Name (Legal Business Name): HEATHER MARIE LAMBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 RUTH HENTZ AVE
PANAMA CITY FL
32405-2258
US

IV. Provider business mailing address

718 E PINE FOREST DR
LYNN HAVEN FL
32444-4322
US

V. Phone/Fax

Practice location:
  • Phone: 850-628-1713
  • Fax:
Mailing address:
  • Phone: 850-227-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number02617089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: