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NPI Code Detail

MEDICARE: KHATIB LYLES

MEDICARE: KHATIB LYLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1558218131
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHATIB LYLES
Provider Business Mailing Address
First Line : 5415 SW WESTGATE DR
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2409
Country : US
Telephone Number : 503-645-3581
Fax Number :
Provider Business Practice Location Address
First Line : 10714 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97220-4046
Country : US
Telephone Number : 503-645-3581
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “ KHATIB LYLES ” Practice Location

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