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General NPI Number Information
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NPI Number | 1487278982
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Entity Type | Individual
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Provider Name | EDWARD L LYELL MA
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Gender | Male
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 9699 N FAIRY LILLY DR
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City | CITRUS SPRINGS
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State | FL
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Zip | 34433-4052
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Country | US
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Telephone | 505-730-6403
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Fax |
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Provider Business Mailing Address
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Address Line | 7005 PROSPECT PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4311
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Country | US
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Telephone | 104-200-6502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CCMH0171851
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH23167
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License Number State | FL
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