1982691010 NPI number — DR. MATTHEW EDWARD LAMBERT PH.D.

Table of content: DR. MATTHEW EDWARD LAMBERT PH.D. (NPI 1982691010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982691010 NPI number — DR. MATTHEW EDWARD LAMBERT PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMBERT
Provider First Name:
MATTHEW
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982691010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1315 WATERS EDGE DR. #112B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANBURY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76048-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-876-6056
Provider Business Mailing Address Fax Number:
817-607-8203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 WATERS EDGE DR. #112B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANBURY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76048-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-876-6056
Provider Business Practice Location Address Fax Number:
817-607-8203
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PSY-202896 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: PSY-202896 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: 23743 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X , with the licence number: 23743 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 431481107001 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: PSY23743TX . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 97338 . This is a "VALUE OPTIONS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00F98C . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 033272801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 680001038 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: N5822 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117301100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 140714100 . This is a "ACL USDL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4712364277 . This is a "TEAM CHOICE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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