Provider Demographics
NPI:1235810672
Name:LYONS, JUSTIN HARRISON (CADC-I, QMHA-R)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:HARRISON
Last Name:LYONS
Suffix:
Gender:M
Credentials:CADC-I, QMHA-R
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:HARRISON
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SILVA
Mailing Address - Street 1:310 GAMAY DR
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-9205
Mailing Address - Country:US
Mailing Address - Phone:541-733-4249
Mailing Address - Fax:
Practice Address - Street 1:310 GAMAY DR
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9205
Practice Address - Country:US
Practice Address - Phone:541-733-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)