Healthcare Provider Details

I. General information

NPI: 1699049726
Provider Name (Legal Business Name): LYTLE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21351 GENTRY DR SUITE 250
STERLING VA
20166-8510
US

IV. Provider business mailing address

160 CANAL ST
HOLLIDAYSBURG PA
16648-1741
US

V. Phone/Fax

Practice location:
  • Phone: 412-921-7000
  • Fax: 412-921-7261
Mailing address:
  • Phone: 412-921-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA PASS
Title or Position: CEO
Credential:
Phone: 412-921-7000