Provider Demographics
NPI:1720593296
Name:VANESSA COCA-LYLE PHD
Entity Type:Organization
Organization Name:VANESSA COCA-LYLE PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COCA-LYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:806-419-1266
Mailing Address - Street 1:3011 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1405
Mailing Address - Country:US
Mailing Address - Phone:817-401-0062
Mailing Address - Fax:
Practice Address - Street 1:5502 58TH ST STE 600
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-2087
Practice Address - Country:US
Practice Address - Phone:806-419-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37544103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty