Provider Demographics
NPI:1023024783
Name:RAPP, LYLE R (MFT)
Entity Type:Individual
Prefix:MR
First Name:LYLE
Middle Name:R
Last Name:RAPP
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14771 PLAZA DR
Mailing Address - Street 2:STE L
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2701
Mailing Address - Country:US
Mailing Address - Phone:714-639-4223
Mailing Address - Fax:714-848-5184
Practice Address - Street 1:14771 PLAZA DR
Practice Address - Street 2:STE L
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2701
Practice Address - Country:US
Practice Address - Phone:714-639-4223
Practice Address - Fax:714-848-5804
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT21776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist