Provider Demographics
NPI:1891072344
Name:LYTLE, VIRGINA ALLEN
Entity Type:Individual
Prefix:
First Name:VIRGINA
Middle Name:ALLEN
Last Name:LYTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 LANSBROOK LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2220
Mailing Address - Country:US
Mailing Address - Phone:405-720-0851
Mailing Address - Fax:
Practice Address - Street 1:9221 LANSBROOK LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-2220
Practice Address - Country:US
Practice Address - Phone:405-720-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKK081062161101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor