Provider Demographics
NPI:1366703472
Name:LYTLE, LINDA R (LPCC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:LYTLE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MORRIS RD SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-5242
Mailing Address - Country:US
Mailing Address - Phone:505-866-2302
Mailing Address - Fax:505-866-2309
Practice Address - Street 1:750 MORRIS RD SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-5242
Practice Address - Country:US
Practice Address - Phone:505-866-2302
Practice Address - Fax:505-866-2309
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI124381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health