Individual provider Active NPI

Vanessa Albina Coca-Lyle, PH.D.

  • Psychologist
  • Lubbock, TX
National Provider Identifier
1790298040
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
37544 Issued in TX
Practice address
5502 58TH St Ste 600
Lubbock, TX 79414-2087
Phone
(806) 419-1266
NPI assigned
Nov 8, 2017
Last updated
Dec 6, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 37544 TX Primary

Addresses

Primary practice location

5502 58TH St Ste 600
Lubbock, TX 79414-2087

Mailing address

3011 20TH St
Lubbock, TX 79410-1405
Phone (806) 419-1266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180112001269 TX Practitioner - Clinical Psychologist 0749549061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3223 S Loop
289 Suite 416
Lubbock, TX 79423-1365
Phone (806) 281-0911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
37544TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Vanessa Coca-Lyle PHD Psychologist CurrentSince Jan 1, 2018 Accepting new patients

Locations

3223 S Loop 289
Ste 416
Lubbock, TX 79423
Phone (806) 281-0911

5502 58th St
Ste 600
Lubbock, TX 79414
Phone (806) 792-3808

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512518400000",
    "number": "1790298040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 20TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101405",
            "telephone_number": "806-419-1266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5502 58TH ST STE 600",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794142087",
            "telephone_number": "806-419-1266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COCA-LYLE",
        "first_name": "VANESSA",
        "middle_name": "ALBINA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-08",
        "last_updated": "2017-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "TX",
            "license": "37544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.