Provider Demographics
NPI:1437254240
Name:LYALL, JAMES M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:LYALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6475 FRIARWOOD CIRCLE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-305-9860
Mailing Address - Fax:330-433-0094
Practice Address - Street 1:4041 BATTON ST NW
Practice Address - Street 2:SUITE 108
Practice Address - City:N CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-305-9860
Practice Address - Fax:330-433-0094
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH2768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0405467Medicaid
OH0405467Medicaid