Provider Demographics
NPI:1003809740
Name:LAMB, SHARON GRACE (LP LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:GRACE
Last Name:LAMB
Suffix:
Gender:F
Credentials:LP LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6942
Mailing Address - Country:US
Mailing Address - Phone:651-290-9088
Mailing Address - Fax:
Practice Address - Street 1:1137 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6942
Practice Address - Country:US
Practice Address - Phone:651-290-9088
Practice Address - Fax:651-290-9311
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MNLP2062103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
63675WIOtherBCBS
N009689OtherCHAMPUS
MN818250700Medicaid
MN818250700Medicaid