Provider Demographics
NPI:1700412251
Name:LAMBORN, ALYSSA (QMHP-CS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LAMBORN
Suffix:
Gender:F
Credentials:QMHP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 N LOOP 1604 W STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4551
Mailing Address - Country:US
Mailing Address - Phone:210-273-4085
Mailing Address - Fax:
Practice Address - Street 1:2822 N LOOP 1604 W STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-4551
Practice Address - Country:US
Practice Address - Phone:210-273-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health