Provider Demographics
NPI:1003204777
Name:LYONS, EILEEN (PHD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 ESTERO PARK COMMONS BLVD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3218
Mailing Address - Country:US
Mailing Address - Phone:239-898-2021
Mailing Address - Fax:
Practice Address - Street 1:9180 ESTERO PARK COMMONS BLVD
Practice Address - Street 2:UNIT 2
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3218
Practice Address - Country:US
Practice Address - Phone:239-898-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5673103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist