Provider Demographics
NPI:1821095274
Name:LYTLE, RICHARD ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:LYTLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:444 E COLLEGE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5558
Mailing Address - Country:US
Mailing Address - Phone:814-238-6380
Mailing Address - Fax:814-238-5923
Practice Address - Street 1:444 E COLLEGE AVE
Practice Address - Street 2:STE 310
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5558
Practice Address - Country:US
Practice Address - Phone:814-238-6380
Practice Address - Fax:814-238-5923
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006279-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR787735Medicare UPIN