Provider Demographics
NPI:1538225669
Name:GILES, LYNDA S (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:S
Last Name:GILES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WESTMOOR RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1359
Mailing Address - Country:US
Mailing Address - Phone:248-932-8899
Mailing Address - Fax:248-851-1815
Practice Address - Street 1:6300 WESTMOOR RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1359
Practice Address - Country:US
Practice Address - Phone:248-932-8899
Practice Address - Fax:248-851-1815
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI029974OtherVALUE OPTIONS
MI68OF33184OtherBLUE CROSS, PSYCHOLOGIST
MI7937108OtherAETNA