Provider Demographics
NPI:1124591367
Name:LAMBRIX, JESSICA LIN (MS, PPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LIN
Last Name:LAMBRIX
Suffix:
Gender:F
Credentials:MS, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S CENTER ST STE 304
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2543
Mailing Address - Country:US
Mailing Address - Phone:307-262-8572
Mailing Address - Fax:
Practice Address - Street 1:141 S CENTER ST STE 304
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2543
Practice Address - Country:US
Practice Address - Phone:307-262-8572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
WYPPC-1317101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker