| Doctor Name: | KIM JEANNETTE LYTLE |
| NPI Number: | 1417304791 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS LLPC |
| License Number: | 6401014824 |
| Business Practice Address: | 520 N Main St Suite 202 Cheboygan, MI - 497211162 |
| Business Phone Number: | 2315979235 |
| Business Fax Number: | 2316274201 |
| Mailing Address: | 520 N Main St, Suite 202 CHEBOYGAN |
| State: | MI |
| Postal Code: | 497211162 |
| Phone Number: | 2315979235 |
| Fax Number: | 2316274201 |
| NPI Enumeration Date: | 05/17/2016 |
| NPI Last Update Date: | 05/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6401014824 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |