Provider Demographics
NPI:1992465777
Name:LAMB, JEFFREY G (AMFT 117522)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:G
Last Name:LAMB
Suffix:
Gender:M
Credentials:AMFT 117522
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RANCHEROS DR STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2978
Mailing Address - Country:US
Mailing Address - Phone:760-566-5516
Mailing Address - Fax:760-692-1831
Practice Address - Street 1:330 RANCHEROS DR STE 208
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2978
Practice Address - Country:US
Practice Address - Phone:760-566-5516
Practice Address - Fax:760-692-1831
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty