Provider Demographics
NPI:1093774796
Name:MCGEE-LYTLE INC
Entity Type:Organization
Organization Name:MCGEE-LYTLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HENRIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGEE-LYTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:260-422-9800
Mailing Address - Street 1:2020 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46803-1327
Mailing Address - Country:US
Mailing Address - Phone:260-422-9800
Mailing Address - Fax:260-422-9882
Practice Address - Street 1:2020 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 650
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803-1327
Practice Address - Country:US
Practice Address - Phone:260-422-9800
Practice Address - Fax:260-422-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty