MEDICARE: DANIEL RICHARD LYTLE M.S.W., L.I.S.W.

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	101YM0800X	Mental Health Counselor	I 0001276	OH

General Provider Information

NPI Number	:	1922027432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL RICHARD LYTLE M.S.W., L.I.S.W.

Provider Business Mailing Address
First Line	:	500 W WILSON BRIDGE RD
Second Line	:	240
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2238
Country	:	US
Telephone Number	:	614-847-8242
Fax Number	:	614-847-9322

Provider Business Practice Location Address
First Line	:	500 W WILSON BRIDGE RD
Second Line	:	240
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2238
Country	:	US
Telephone Number	:	614-847-8242
Fax Number	:	614-847-9322

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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