MEDICARE: MCGEE-LYTLE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	20040231	IN

General Provider Information

NPI Number	:	1093774796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCGEE-LYTLE INC

Provider Business Mailing Address
First Line	:	2020 E WASHINGTON BLVD
Second Line	:	SUITE 650
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-1327
Country	:	US
Telephone Number	:	260-422-9800
Fax Number	:	260-422-9882

Provider Business Practice Location Address
First Line	:	2020 E WASHINGTON BLVD
Second Line	:	SUITE 650
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-1327
Country	:	US
Telephone Number	:	260-422-9800
Fax Number	:	260-422-9882

Authorized Official
Title or Position	:	CEO
Name	:	HENRIA D MCGEE-LYTLE
Credential	:	PH.D
Telephone Number	:	260-422-9800

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/22/2020

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Directions to “MCGEE-LYTLE INC ” Practice Location

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