Provider Demographics
NPI:1265843882
Name:O'DONNELL LYONS, PENNEY (LMHC)
Entity Type:Individual
Prefix:
First Name:PENNEY
Middle Name:
Last Name:O'DONNELL LYONS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 CARDINAL POINT DR STE 204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-9238
Mailing Address - Country:US
Mailing Address - Phone:904-737-7242
Mailing Address - Fax:904-737-7254
Practice Address - Street 1:3560 CARDINAL POINT DR STE 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-9238
Practice Address - Country:US
Practice Address - Phone:904-737-7242
Practice Address - Fax:904-737-7254
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health