Healthcare Provider Details

I. General information

NPI: 1740847441
Provider Name (Legal Business Name): DONALD LEE LYKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 UNION ST
BEDFORD OH
44146-4569
US

IV. Provider business mailing address

314 UNION ST
BEDFORD OH
44146-4569
US

V. Phone/Fax

Practice location:
  • Phone: 216-332-9360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: