Provider Demographics
NPI:1235508482
Name:LAMBERT THERAPY SERVICES OF PICAYUNE, LLC
Entity Type:Organization
Organization Name:LAMBERT THERAPY SERVICES OF PICAYUNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:769-926-2441
Mailing Address - Street 1:317 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3313
Mailing Address - Country:US
Mailing Address - Phone:769-926-2441
Mailing Address - Fax:769-926-2442
Practice Address - Street 1:317 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3313
Practice Address - Country:US
Practice Address - Phone:769-926-2441
Practice Address - Fax:769-926-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07339843Medicaid