Provider Demographics
NPI:1396882023
Name:LYTLE, THOMAS A (LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:LYTLE
Suffix:
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 1:2801 E PALMER WASILLA HWY STE A
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7339
Mailing Address - Country:US
Mailing Address - Phone:907-373-5331
Mailing Address - Fax:907-373-5334
Practice Address - Street 1:2801 E PALMER WASILLA HWY STE A
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7339
Practice Address - Country:US
Practice Address - Phone:907-373-5331
Practice Address - Fax:907-373-5334
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCOP330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225341969OtherNPPES