Healthcare Provider Details

I. General information

NPI: 1184080756
Provider Name (Legal Business Name): LYLE MARGUERITE MARGO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYLE MARGUERITE TRUSCOTT LMFT

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 FOLSOM ST STE 702
SAN FRANCISCO CA
94107-4502
US

IV. Provider business mailing address

PO BOX 1911
MILL VALLEY CA
94942-1911
US

V. Phone/Fax

Practice location:
  • Phone: 415-271-3278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: