Provider Demographics
NPI:1578350690
Name:LAMBERT, JACOB D
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:D
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-6943
Mailing Address - Country:US
Mailing Address - Phone:850-400-6098
Mailing Address - Fax:866-265-8817
Practice Address - Street 1:1001 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6943
Practice Address - Country:US
Practice Address - Phone:850-400-6098
Practice Address - Fax:866-265-8817
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-428907106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician