Healthcare Provider Details

I. General information

NPI: 1801928767
Provider Name (Legal Business Name): STEVEN KYLE LYTLE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 N JOSEY LN STE 250
CARROLLTON TX
75007-5538
US

IV. Provider business mailing address

2625 N. JOSEY LANE
CARROLLTON TX
75007
US

V. Phone/Fax

Practice location:
  • Phone: 972-466-2800
  • Fax:
Mailing address:
  • Phone: 972-466-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18343
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: