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General NPI Number Information
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NPI Number | 1770061178
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Entity Type | Individual
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Provider Name | LYLE ALLEN HOLTHUS SCHOOL PSYCHOLOGIST
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Gender | Male
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 2840 NW 2ND AVE STE 104
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City | BOCA RATON
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State | FL
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Zip | 33431-6692
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Country | US
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Telephone | 800-233-5976
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Fax | 800-238-3365
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Provider Business Mailing Address
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Address Line | 2840 NW 2ND AVE STE 104
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City | BOCA RATON
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State | FL
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Zip | 33431-6692
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Country | US
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Telephone | 800-233-5976
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Fax | 800-238-3365
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1525226142
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License Number State | KS
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