Provider Demographics
NPI:1689418733
Name:LYLES, MARY ELIZABETH CHAPPELL
Entity type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:CHAPPELL
Last Name:LYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 VERDON DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3208
Mailing Address - Country:US
Mailing Address - Phone:617-755-2650
Mailing Address - Fax:
Practice Address - Street 1:1845 PEELER RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5710
Practice Address - Country:US
Practice Address - Phone:404-493-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health