Provider Demographics
NPI:1508680695
Name:LOFTON, NYLA (BD)
Entity type:Individual
Prefix:
First Name:NYLA
Middle Name:
Last Name:LOFTON
Suffix:
Gender:F
Credentials:BD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14431 ELM ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1903
Mailing Address - Country:US
Mailing Address - Phone:248-906-6871
Mailing Address - Fax:
Practice Address - Street 1:306 WYNN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-1961
Practice Address - Country:US
Practice Address - Phone:256-882-2457
Practice Address - Fax:256-882-2459
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBACB1123610106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician