Provider Demographics
NPI:1205403664
Name:LYONS, ANTOINETTE ROMAINE (LMFT-I)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:ROMAINE
Last Name:LYONS
Suffix:
Gender:F
Credentials:LMFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7376
Mailing Address - Country:US
Mailing Address - Phone:702-565-1020
Mailing Address - Fax:702-565-1035
Practice Address - Street 1:3376 S EASTERN AVE STE 148
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3367
Practice Address - Country:US
Practice Address - Phone:702-272-0025
Practice Address - Fax:702-920-8226
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF87998106H00000X
NVM14004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty