Provider Demographics
NPI:1649784836
Name:LAMB, MALLORY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:LAMB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 BIG BEND RD # 857
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7735
Mailing Address - Country:US
Mailing Address - Phone:715-360-4711
Mailing Address - Fax:
Practice Address - Street 1:613 BIG BEND RD # 857
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-7735
Practice Address - Country:US
Practice Address - Phone:715-360-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical