Provider Demographics
NPI:1093140410
Name:LYLES, LAUREN MARIE
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:MARIE
Last Name:LYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-2146
Mailing Address - Country:US
Mailing Address - Phone:864-886-4400
Mailing Address - Fax:
Practice Address - Street 1:810 W SOUTH 4TH ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3324
Practice Address - Country:US
Practice Address - Phone:864-886-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator