Provider Demographics
NPI:1164961850
Name:LAMBERT, MYESHA
Entity Type:Individual
Prefix:
First Name:MYESHA
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-2221
Mailing Address - Country:US
Mailing Address - Phone:251-223-7728
Mailing Address - Fax:
Practice Address - Street 1:1109 CARTER ST STE 10
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3227
Practice Address - Country:US
Practice Address - Phone:318-336-4700
Practice Address - Fax:318-336-4777
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
LA14536104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator