Provider Demographics
NPI:1003643115
Name:LYLE, CHRISTOPER MAURICE (LADAC II)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPER
Middle Name:MAURICE
Last Name:LYLE
Suffix:
Gender:M
Credentials:LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 DALEMORE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8238
Mailing Address - Country:US
Mailing Address - Phone:901-653-8352
Mailing Address - Fax:
Practice Address - Street 1:912 DALEMORE LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8238
Practice Address - Country:US
Practice Address - Phone:901-653-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1628101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty