Provider Demographics
NPI:1184080756
Name:MARGO, LYLE MARGUERITE (LMFT)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:MARGUERITE
Last Name:MARGO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LYLE
Other - Middle Name:MARGUERITE
Other - Last Name:TRUSCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1911
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-1911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:832 FOLSOM ST STE 702
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-4502
Practice Address - Country:US
Practice Address - Phone:415-271-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121394106H00000X
CARBT-16-15166106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician