Provider Demographics
NPI:1316234255
Name:LAMB, KATHY ANDERSON (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANDERSON
Last Name:LAMB
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 WESTOVER HTS
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-1106
Mailing Address - Country:US
Mailing Address - Phone:662-554-9031
Mailing Address - Fax:
Practice Address - Street 1:105A N 2ND ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3207
Practice Address - Country:US
Practice Address - Phone:662-554-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst