Provider Demographics
NPI:1164607917
Name:LYON, RICHARD SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:LYON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E WALNUT ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1452
Mailing Address - Country:US
Mailing Address - Phone:818-957-5750
Mailing Address - Fax:626-568-0340
Practice Address - Street 1:1000 E WALNUT ST
Practice Address - Street 2:SUITE 225
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1452
Practice Address - Country:US
Practice Address - Phone:818-957-5750
Practice Address - Fax:626-568-0340
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist