Healthcare Provider Details

I. General information

NPI: 1275479073
Provider Name (Legal Business Name): FUTSUN LYTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LYTH

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MAIN ST STE 201
WALLA WALLA WA
99362-1900
US

IV. Provider business mailing address

103 E MAIN ST STE 201
WALLA WALLA WA
99362-1900
US

V. Phone/Fax

Practice location:
  • Phone: 509-301-3270
  • Fax: 509-231-7219
Mailing address:
  • Phone: 509-301-3270
  • Fax: 509-231-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: