Provider Demographics
NPI:1568661197
Name:LYLES, LA RAYE LYNETTE (MA)
Entity type:Individual
Prefix:MS
First Name:LA RAYE
Middle Name:LYNETTE
Last Name:LYLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-632-2576
Practice Address - Street 1:8711 MACARTHUR BLVD
Practice Address - Street 2:A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4000
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-632-2576
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist