Healthcare Provider Details

I. General information

NPI: 1164914545
Provider Name (Legal Business Name): GABRIELLE LYLES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

IV. Provider business mailing address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

V. Phone/Fax

Practice location:
  • Phone: 216-321-6511
  • Fax:
Mailing address:
  • Phone: 216-321-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1902380
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1801086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: