Basic Information
| Provider Information | |||||||||
| NPI: | 1508103946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYLES | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | ARNEZ | ||||||||
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| Credential: | LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 S MAIN AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782041128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108229493 | ||||||||
| FaxNumber: | 2108228733 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 S MAIN AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782041128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108229493 | ||||||||
| FaxNumber: | 2108228733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2013 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 9769 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.