Provider Demographics
NPI:1679630727
Name:HOXTELL, LYLE DEAN (LAC)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:DEAN
Last Name:HOXTELL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1292
Mailing Address - Country:US
Mailing Address - Phone:218-739-0886
Mailing Address - Fax:
Practice Address - Street 1:217 E HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1292
Practice Address - Country:US
Practice Address - Phone:218-739-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)