Provider Demographics
NPI:1548217532
Name:LYLE, JAMES DONALD (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:LYLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5152
Mailing Address - Country:US
Mailing Address - Phone:281-482-5999
Mailing Address - Fax:291-993-2354
Practice Address - Street 1:211 E PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5174
Practice Address - Country:US
Practice Address - Phone:281-482-5999
Practice Address - Fax:291-993-2354
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS189901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S60TMedicare ID - Type Unspecified