Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 99999 | TX |
NPI | 1083188791 |
---|---|
Provider Name | Tommy Brian Lambert |
First Address | Pasadena, TX 77505-4511 |
Second Address | Pasadena, TX 77505-4511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2019 |
Last Update Date | 15/01/2019 |