Provider Demographics
NPI:1093731028
Name:LYONS, GARY FRANKLIN (LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:FRANKLIN
Last Name:LYONS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HAWTHORN ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-9440
Mailing Address - Country:US
Mailing Address - Phone:304-952-2583
Mailing Address - Fax:304-425-3707
Practice Address - Street 1:306 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-9440
Practice Address - Country:US
Practice Address - Phone:304-952-2583
Practice Address - Fax:304-425-3707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040017371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008937362Medicaid
VA008926646Medicaid
VA142953OtherBCBS VA
VA800002837Medicare PIN
VA008937362Medicaid
VA$$$$$$$$$Medicare PIN