Provider Demographics
NPI:1376963900
Name:HAWTHORNE, LYLE
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:
Last Name:HAWTHORNE
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 1:1805 S. OHIO ST.
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-2117
Mailing Address - Country:US
Mailing Address - Phone:785-825-6224
Mailing Address - Fax:785-827-7895
Practice Address - Street 1:839 N EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2017
Practice Address - Country:US
Practice Address - Phone:785-762-3700
Practice Address - Fax:785-762-3704
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)