Healthcare Provider Details

I. General information

NPI: 1851784441
Provider Name (Legal Business Name): BETTY LYTLE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HUMAHUACA ST
PAHRUMP NV
89048-2199
US

IV. Provider business mailing address

240 HUMAHUACA ST
PAHRUMP NV
89048-2199
US

V. Phone/Fax

Practice location:
  • Phone: 775-751-7406
  • Fax: 775-751-7409
Mailing address:
  • Phone: 775-751-7406
  • Fax: 775-751-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6212-S
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: