Provider Demographics
NPI:1417304791
Name:LYTLE, KIM JEANNETTE (MS LPC CAADC NCC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:JEANNETTE
Last Name:LYTLE
Suffix:
Gender:F
Credentials:MS LPC CAADC NCC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:520 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1162
Mailing Address - Country:US
Mailing Address - Phone:231-597-9235
Mailing Address - Fax:231-627-4201
Practice Address - Street 1:520 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1162
Practice Address - Country:US
Practice Address - Phone:231-597-9235
Practice Address - Fax:231-627-4201
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6401014824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health