Provider Demographics
NPI:1225546609
Name:LYONS, TOLITHIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:TOLITHIA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:TOLITHIA
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AP
Mailing Address - Street 1:107 W ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4403
Mailing Address - Country:US
Mailing Address - Phone:318-224-7170
Mailing Address - Fax:318-224-7063
Practice Address - Street 1:107 W ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4403
Practice Address - Country:US
Practice Address - Phone:318-588-5012
Practice Address - Fax:318-518-5008
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty