Provider Demographics
NPI:1982691010
Name:LAMBERT, MATTHEW EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDWARD
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 WATERS EDGE DR. #112B
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1300
Mailing Address - Country:US
Mailing Address - Phone:817-876-6056
Mailing Address - Fax:817-607-8203
Practice Address - Street 1:1315 WATERS EDGE DR. #112B
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1300
Practice Address - Country:US
Practice Address - Phone:817-876-6056
Practice Address - Fax:817-607-8203
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202896103G00000X, 103TC1900X
TX23743103TC1900X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX431481107001OtherTRICARE/CHAMPUS
TXPSY23743TXOtherWORKER'S COMPENSATION
TX97338OtherVALUE OPTIONS
TX00F98COtherBCBS
TX033272801Medicaid
TX680001038OtherMEDICARE RR
NMN5822Medicaid
TX117301100OtherFIRSTCARE
TX140714100OtherACL USDL
TX4712364277OtherTEAM CHOICE