Provider Demographics
NPI:1659521805
Name:LYLE, LORI A (MA LPC #770)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:LYLE
Suffix:
Gender:F
Credentials:MA LPC #770
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-2129
Mailing Address - Country:US
Mailing Address - Phone:307-684-5384
Mailing Address - Fax:
Practice Address - Street 1:334 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-2129
Practice Address - Country:US
Practice Address - Phone:307-684-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY770101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor