Provider Demographics
NPI:1790298040
Name:COCA-LYLE, VANESSA ALBINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:ALBINA
Last Name:COCA-LYLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:806-419-1266
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:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
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