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General NPI Number Information
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NPI Number | 1679875520
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Entity Type | Organization
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Legal Business Name | MARK LYTLE ASSOCIATES A PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 3636 4TH AVE #302
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City | SAN DIEGO
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State | CA
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Zip | 92103-4280
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Country | US
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Telephone | 858-566-4748
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Fax | 858-566-4748
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Provider Business Mailing Address
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Address Line | 11280 TRIBUNA AVE
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City | SAN DIEGO
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State | CA
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Zip | 92131-1929
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Country | US
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Telephone | 858-566-4748
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Fax | 858-566-4748
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK S LYTLE
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Credential | PSYD
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Telephone | 858-566-4748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY12089
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License Number State | CA
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