Provider Demographics
NPI:1003622838
Name:SIRLES, LOLA LEWIS
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:LEWIS
Last Name:SIRLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2536
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7536
Mailing Address - Country:US
Mailing Address - Phone:903-675-9570
Mailing Address - Fax:903-675-9577
Practice Address - Street 1:700 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3342
Practice Address - Country:US
Practice Address - Phone:903-657-9570
Practice Address - Fax:903-657-9577
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX586761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical