Provider Demographics
NPI:1235216599
Name:LYLE, RANDALL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:R
Last Name:LYLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 GARDENDALE ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3475
Mailing Address - Country:US
Mailing Address - Phone:210-593-9725
Mailing Address - Fax:210-593-9714
Practice Address - Street 1:4230 GARDENDALE ST
Practice Address - Street 2:SUITE 502
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3475
Practice Address - Country:US
Practice Address - Phone:210-593-9725
Practice Address - Fax:210-593-9714
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8241BHOtherBCBS