Provider Demographics
NPI:1992856363
Name:LYLE, WENDY K (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:K
Last Name: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 1:438 COLUSA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4148
Mailing Address - Country:US
Mailing Address - Phone:530-755-0735
Mailing Address - Fax:530-755-0737
Practice Address - Street 1:438 COLUSA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4148
Practice Address - Country:US
Practice Address - Phone:530-755-0735
Practice Address - Fax:530-755-0737
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical