1770735458 NPI number — NATASHA LYLES MS

Table of content: NATASHA LYLES MS (NPI 1770735458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770735458 NPI number — NATASHA LYLES MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYLES
Provider First Name:
NATASHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770735458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S EDWIN C MOSES BLVD
Provider Second Line Business Mailing Address:
SAMARITAN BEHAVIORAL HEALTH INC, 4TH FLOOR NW BLDG
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45417-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-734-8333
Provider Business Mailing Address Fax Number:
937-734-4343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S EDWIN C MOSES BLVD
Provider Second Line Business Practice Location Address:
SAMARITAN BEHAVIORAL HEALTH INC,
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45417-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-283-1107
Provider Business Practice Location Address Fax Number:
574-283-1131
Provider Enumeration Date:
10/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)