Provider Demographics
NPI:1700627908
Name:LAMBETH, ABBY GENE (PCLC)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:GENE
Last Name:LAMBETH
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46289 LAKE MARY RONAN RD
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59929-9705
Mailing Address - Country:US
Mailing Address - Phone:309-242-9021
Mailing Address - Fax:
Practice Address - Street 1:7235 US HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:MT
Practice Address - Zip Code:59922-9812
Practice Address - Country:US
Practice Address - Phone:309-242-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-71267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional