Provider Demographics
NPI:1275908428
Name:LYONS, ALAN THOMAS
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:THOMAS
Last Name:LYONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S ELIZABETH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2547
Mailing Address - Country:US
Mailing Address - Phone:801-413-6826
Mailing Address - Fax:
Practice Address - Street 1:350 E. 2100 S.
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UTAH
Practice Address - Zip Code:84115
Practice Address - Country:UM
Practice Address - Phone:801-413-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YA0400X
101YA0400X
UT390200000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)