MEDICARE: MS. TANYA ANNE LAMBERT MS, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	CC01211	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC01211	OTHER	MN	BOARD OF BEHAVIORAL HEALTH AND THERAPY

General Provider Information

NPI Number	:	1679929640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANYA ANNE LAMBERT MS, LPCC

Provider Business Mailing Address
First Line	:	PO BOX 2390
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56302-2390
Country	:	US
Telephone Number	:	320-650-1545
Fax Number	:	320-650-1510

Provider Business Practice Location Address
First Line	:	508 FREEPORT AVE NW
Second Line	:	SUITE D
City	:	ELK RIVER
State	:	MN
Zip	:	55330-1873
Country	:	US
Telephone Number	:	763-441-1578
Fax Number	:	763-441-1740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	05/10/2016

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