Provider Demographics
NPI:1265863153
Name:LYLE, ASHLEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:LYLE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 N UNIVERSITY ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8302
Mailing Address - Country:US
Mailing Address - Phone:309-863-2593
Mailing Address - Fax:309-966-0861
Practice Address - Street 1:7820 N UNIVERSITY ST STE 204
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8302
Practice Address - Country:US
Practice Address - Phone:309-863-2593
Practice Address - Fax:309-966-0861
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490168071041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty