MEDICARE: LYLE THAMES

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
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1740110196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYLE THAMES

Provider Business Mailing Address
First Line	:	2344 NW 198TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-5221
Country	:	US
Telephone Number	:	480-549-3065
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 RICHMOND SQ
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2061
Country	:	US
Telephone Number	:	480-549-3065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ LYLE THAMES ” Practice Location

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