MEDICARE: MS. LA RAYE LYNETTE LYLES M.A.

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	106H00000X	Marriage & Family Therapist	47186	CA

General Provider Information

NPI Number	:	1568661197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LA RAYE LYNETTE LYLES M.A.

Provider Business Mailing Address
First Line	:	747 52ND ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1809
Country	:	US
Telephone Number	:	510-428-3885
Fax Number	:	510-632-2576

Provider Business Practice Location Address
First Line	:	8711 MACARTHUR BLVD
Second Line	:	A
City	:	OAKLAND
State	:	CA
Zip	:	94605-4000
Country	:	US
Telephone Number	:	510-428-3885
Fax Number	:	510-632-2576

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	01/31/2025

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Directions to “ MS. LA RAYE LYNETTE LYLES M.A.” Practice Location

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