Provider Demographics
NPI:1184778870
Name:LYLE-LAHROUD, TERESA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:LYLE-LAHROUD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:LYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21384 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7580
Mailing Address - Country:US
Mailing Address - Phone:713-459-6084
Mailing Address - Fax:281-528-8276
Practice Address - Street 1:21384 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7580
Practice Address - Country:US
Practice Address - Phone:713-459-6084
Practice Address - Fax:281-528-8276
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33206103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182349404Medicaid