Provider Demographics
NPI:1124595400
Name:LYON, KATIE RENEE (MT-BC, LPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:RENEE
Last Name:LYON
Suffix:
Gender:F
Credentials:MT-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 OAK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088
Mailing Address - Country:US
Mailing Address - Phone:817-454-9930
Mailing Address - Fax:
Practice Address - Street 1:3687 OAK CIRCLE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76088
Practice Address - Country:US
Practice Address - Phone:817-454-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
TX80507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist