Provider Demographics
NPI:1578367629
Name:LYLE, JEMINA
Entity type:Individual
Prefix:
First Name:JEMINA
Middle Name:
Last Name:LYLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 S HAMILTON AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1377
Mailing Address - Country:US
Mailing Address - Phone:202-281-9609
Mailing Address - Fax:
Practice Address - Street 1:3655 S HAMILTON AVE APT 2R
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1377
Practice Address - Country:US
Practice Address - Phone:202-281-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor