Provider Demographics
NPI:1255039939
Name:LYLES, DEBRA (LSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:LYLES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PUMA LANE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623
Mailing Address - Country:US
Mailing Address - Phone:805-728-0070
Mailing Address - Fax:
Practice Address - Street 1:77 PUMA LANE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-8162
Practice Address - Country:US
Practice Address - Phone:805-728-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00099246111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical