Healthcare Provider Details

I. General information

NPI: 1386488294
Provider Name (Legal Business Name): LYLE GIVENS AAS, SUDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1956 NE KRESKY AVE
CHEHALIS WA
98532-2307
US

IV. Provider business mailing address

PO BOX 59
CHEHALIS WA
98532-0059
US

V. Phone/Fax

Practice location:
  • Phone: 360-740-4380
  • Fax: 360-740-1877
Mailing address:
  • Phone: 360-740-4380
  • Fax: 360-740-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP70106744
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCO61532256
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: