Healthcare Provider Details

I. General information

NPI: 1922027432
Provider Name (Legal Business Name): DANIEL RICHARD LYTLE M.S.W., L.I.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. DANIEL RICHARD LYTLE III

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W WILSON BRIDGE RD 240
WORTHINGTON OH
43085-2238
US

IV. Provider business mailing address

500 W WILSON BRIDGE RD 240
WORTHINGTON OH
43085-2238
US

V. Phone/Fax

Practice location:
  • Phone: 614-847-8242
  • Fax: 614-847-9322
Mailing address:
  • Phone: 614-847-8242
  • Fax: 614-847-9322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI 0001276
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: