Provider Demographics
NPI:1164201869
Name:LYONS, MADISON DANIELLE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:DANIELLE
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MADISON
Other - Middle Name:DANIELLE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8613 SW 66TH PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73169-6970
Mailing Address - Country:US
Mailing Address - Phone:918-470-2545
Mailing Address - Fax:
Practice Address - Street 1:8613 SW 66TH PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73169-6970
Practice Address - Country:US
Practice Address - Phone:191-847-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health