Provider Demographics
NPI:1235215187
Name:DELL, TINA LYON (MED, NCC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LYON
Last Name:DELL
Suffix:
Gender:F
Credentials:MED, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 OLD LAKE SHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9561
Mailing Address - Country:US
Mailing Address - Phone:716-947-2077
Mailing Address - Fax:
Practice Address - Street 1:6708 OLD LAKE SHORE ROAD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9561
Practice Address - Country:US
Practice Address - Phone:716-947-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11098OtherNATIONALLY CERTIFIED COUN
NY001044OtherLICENSED MENTAL HEALTH CO