Provider Demographics
NPI:1063844645
Name:LYON, ANGELA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-5920
Mailing Address - Country:US
Mailing Address - Phone:308-392-2280
Mailing Address - Fax:308-832-4803
Practice Address - Street 1:223 N LOCUST ST APT 1
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-5930
Practice Address - Country:US
Practice Address - Phone:308-391-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17001041C0700X
NE17721041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025173100Medicaid
NE10025173100Medicaid