Individual
ED DAVIS LYLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
350 CITY VIEW DR, #302, EVANSTON, WY 82930-5327
(307) 789-7915
(307) 789-6009
Mailing address
350 CITY VIEW DR, #302, EVANSTON, WY 82930-5327
(307) 789-7915
(307) 789-6009
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-408
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
313191
BCBS OF WYOMING
WY
Enumeration date
04/10/2007
Last updated
07/09/2007
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