NPI | 1023303922 |
---|---|
Former Name | STARLA NICOLE LYLES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A14833) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102203199) |
261QM0850X Clinic/Center, Adult Mental Health (Licence: CA 20A14833) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2011-06-20 |
Last Update Date | 2021-02-09 |