Provider Demographics
NPI:1497335038
Name:LYLES, KELLY FAITH
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:FAITH
Last Name:LYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 PORTOFINO DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6130
Mailing Address - Country:US
Mailing Address - Phone:760-433-6361
Mailing Address - Fax:
Practice Address - Street 1:1816 PORTOFINO DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6130
Practice Address - Country:US
Practice Address - Phone:760-433-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker