Ed Davis Lyles, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-408 Issued in WY

Practice address

350 City View Dr
#302
Evanston, WY 82930-5327

Phone

(307) 789-7915

Fax

(307) 789-6009

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pioneer Counseling Services

  • Mental Illness Community Based Residential Treatment Facility
  • Evanston, WY
  • NPI 1033954474
  NPD (past)
• Pioneer Counseling Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Evanston, WY
  • NPI 1093792095
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1265655427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 CITY VIEW DR",
            "address_2": "#302",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305327",
            "telephone_number": "307-789-7915",
            "fax_number": "307-789-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 CITY VIEW DR",
            "address_2": "#302",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305327",
            "telephone_number": "307-789-7915",
            "fax_number": "307-789-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYLES",
        "first_name": "ED",
        "middle_name": "DAVIS",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WY",
            "license": "LCSW-408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF WYOMING",
            "identifier": "313191",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Talen Little, DPT
• Janika Long
• Rena Lowe
• Amber Michelle Lowrey, PCSW
• Kaitlyn Lowry
• Tammy Maestas
• Julie B Maggiolo, M.D.
• Gabrielle Markley, LPC
• Mindee Marler, PCSW
• Jason Marsh, PMHNP-BC

• Clinical Social Worker in Evanston, WY
• Providers in Evanston, WY by specialty
• Clinical Social Worker in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.