Provider Demographics
NPI:1316126634
Name:LYLE, JULIE ANNE (PSYD, MFT)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE
Last Name:LYLE
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 JEFFERSON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1737
Mailing Address - Country:US
Mailing Address - Phone:760-945-7383
Mailing Address - Fax:760-726-2215
Practice Address - Street 1:2755 JEFFERSON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1737
Practice Address - Country:US
Practice Address - Phone:760-945-7383
Practice Address - Fax:760-726-2215
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 26075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health