MEDICARE: LYLE HAWTHORNE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1376963900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYLE HAWTHORNE

Provider Business Mailing Address
First Line	:	1805 S. OHIO ST.
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67402-2117
Country	:	US
Telephone Number	:	785-825-6224
Fax Number	:	785-827-7895

Provider Business Practice Location Address
First Line	:	839 N EISENHOWER DR
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-2017
Country	:	US
Telephone Number	:	785-762-3700
Fax Number	:	785-762-3704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	04/22/2014

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Directions to “ LYLE HAWTHORNE ” Practice Location

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