Healthcare Provider Details

I. General information

NPI: 1366763427
Provider Name (Legal Business Name): L. LYNETTE LYTLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 60 22 WEST BLANDYWAY OFFICE PARK
MILLEDGEVILLE GA
31061
US

IV. Provider business mailing address

175 EMERY HWY
MACON GA
31217-3692
US

V. Phone/Fax

Practice location:
  • Phone: 478-445-1290
  • Fax: 478-445-1296
Mailing address:
  • Phone: 478-751-4446
  • Fax: 478-751-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number003628
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: