Provider Demographics
NPI:1083166821
Name:LYON, CHRISTINE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 NAHMA AVE
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1933
Mailing Address - Country:US
Mailing Address - Phone:248-840-2387
Mailing Address - Fax:
Practice Address - Street 1:31815 SOUTHFIELD RD STE 27
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-686-3347
Practice Address - Fax:248-282-7114
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015751101Y00000X, 101YP2500X
MI6401017039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor