Provider Demographics
NPI:1366952541
Name:LAMBERT, JESSE ALAN
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:ALAN
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W 8TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5165
Mailing Address - Country:US
Mailing Address - Phone:619-840-6023
Mailing Address - Fax:
Practice Address - Street 1:620 W 8TH ST APT 1
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5165
Practice Address - Country:US
Practice Address - Phone:619-840-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty