Healthcare Provider Details

I. General information

NPI: 1871234542
Provider Name (Legal Business Name): JAY SAMUEL LYTTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6261 RANDI AVE
WOODLAND HILLS CA
91367-1931
US

IV. Provider business mailing address

6261 RANDI AVE
WOODLAND HILLS CA
91367-1931
US

V. Phone/Fax

Practice location:
  • Phone: 818-458-9759
  • Fax:
Mailing address:
  • Phone: 818-458-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number121030
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: