Provider Demographics
NPI:1306939483
Name:RAKER, LYLE D JR (LPC)
Entity type:Individual
Prefix:MR
First Name:LYLE
Middle Name:D
Last Name:RAKER
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-3407
Mailing Address - Country:US
Mailing Address - Phone:806-342-2500
Mailing Address - Fax:806-372-2433
Practice Address - Street 1:1001 S POLK ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-3407
Practice Address - Country:US
Practice Address - Phone:806-342-2500
Practice Address - Fax:806-372-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180802401Medicaid