Healthcare Provider Details

I. General information

NPI: 1770050999
Provider Name (Legal Business Name): SARAH M LYTLE MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MACKIN RD
FLINT MI
48503-1204
US

IV. Provider business mailing address

1440 TORREY RD STE E
FENTON MI
48430-1340
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3705
  • Fax:
Mailing address:
  • Phone: 248-821-5083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361006902
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: