Provider Demographics
NPI:1659918944
Name:HOLIN, LYLE MARTY II (LMHC)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:MARTY
Last Name:HOLIN
Suffix:II
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6306
Mailing Address - Country:US
Mailing Address - Phone:575-760-0754
Mailing Address - Fax:888-276-3843
Practice Address - Street 1:101 W 4TH ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6306
Practice Address - Country:US
Practice Address - Phone:575-760-0754
Practice Address - Fax:888-276-3843
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0208431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional