Basic Information
Provider Information | |||||||||
NPI: | 1770735458 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LYLES | ||||||||
FirstName: | NATASHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 601 S EDWIN C MOSES BLVD | ||||||||
Address2: | SAMARITAN BEHAVIORAL HEALTH INC, 4TH FLOOR NW BLDG | ||||||||
City: | DAYTON | ||||||||
State: | OH | ||||||||
PostalCode: | 454173424 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9377348333 | ||||||||
FaxNumber: | 9377344343 | ||||||||
Practice Location | |||||||||
Address1: | 601 S EDWIN C MOSES BLVD | ||||||||
Address2: | SAMARITAN BEHAVIORAL HEALTH INC, | ||||||||
City: | DAYTON | ||||||||
State: | OH | ||||||||
PostalCode: | 454173424 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5742831107 | ||||||||
FaxNumber: | 5742831131 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/14/2008 | ||||||||
LastUpdateDate: | 07/01/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor |   |
No ID Information.