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General NPI Number Information
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NPI Number | 1720593296
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Entity Type | Organization
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Legal Business Name | VANESSA COCA-LYLE PHD
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 5502 58TH ST STE 600
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City | LUBBOCK
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State | TX
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Zip | 79414-2087
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Country | US
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Telephone | 806-419-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 3011 20TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1405
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Country | US
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Telephone | 817-401-0062
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. VANESSA COCA-LYLE
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Credential | PHD
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Telephone | 806-419-1266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 37544
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License Number State | TX
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