Provider Demographics
NPI:1710423504
Name:LAMBERTH, SCOTT (MS, MFTI #92984)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:LAMBERTH
Suffix:
Gender:M
Credentials:MS, MFTI #92984
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 10-A
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3465
Mailing Address - Country:US
Mailing Address - Phone:909-890-2381
Mailing Address - Fax:909-890-0580
Practice Address - Street 1:1881 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 10-A
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3465
Practice Address - Country:US
Practice Address - Phone:909-890-2381
Practice Address - Fax:909-890-0580
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92984101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X, 106H00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician