Provider Demographics
NPI:1679929640
Name:LAMBERT, TANYA ANNE (MS, LPCC)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:ANNE
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2390
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-2390
Mailing Address - Country:US
Mailing Address - Phone:320-650-1545
Mailing Address - Fax:320-650-1510
Practice Address - Street 1:508 FREEPORT AVE NW
Practice Address - Street 2:SUITE D
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1873
Practice Address - Country:US
Practice Address - Phone:763-441-1578
Practice Address - Fax:763-441-1740
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCC01211OtherBOARD OF BEHAVIORAL HEALTH AND THERAPY