Provider Demographics
NPI:1851874507
Name:LAMBERT, MIRANDA R (LCSW)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:R
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:GONKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2224 1ST AVE W STE 4
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6286
Mailing Address - Country:US
Mailing Address - Phone:701-572-3335
Mailing Address - Fax:
Practice Address - Street 1:2224 1ST AVE W STE 4
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6286
Practice Address - Country:US
Practice Address - Phone:701-572-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND56411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty