Provider Demographics
NPI:1417494600
Name:LAMB, JUANITA SENIOR
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:SENIOR
Last Name:LAMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:ANN
Other - Last Name:SENIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 7058
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-7058
Mailing Address - Country:US
Mailing Address - Phone:812-298-9797
Mailing Address - Fax:812-298-0343
Practice Address - Street 1:1019 E SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4547
Practice Address - Country:US
Practice Address - Phone:812-298-9797
Practice Address - Fax:812-298-0343
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002391A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical