Provider Demographics
NPI:1316224330
Name:LAMB, JOHN W JR (QMHA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:LAMB
Suffix:JR
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 PIRATE SHIP DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3496
Mailing Address - Country:US
Mailing Address - Phone:702-586-8693
Mailing Address - Fax:702-476-2690
Practice Address - Street 1:5715 W ALEXANDER
Practice Address - Street 2:SUITE 155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2807
Practice Address - Country:US
Practice Address - Phone:702-586-8693
Practice Address - Fax:702-476-2690
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV54627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV274455064OtherQMHA