Healthcare Provider Details

I. General information

NPI: 1548897358
Provider Name (Legal Business Name): YOLONDA S LYSLE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S 1ST ST
LOUISVILLE KY
40203-2202
US

IV. Provider business mailing address

10101 LINN STATION RD STE 600
LOUISVILLE KY
40223-3818
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-9444
  • Fax: 502-585-9466
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number262978
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: