Provider Demographics
NPI:1326161407
Name:LYON, BARRY DEAN
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:DEAN
Last Name:LYON
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 1:9001 S LITCHFORD RD
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8115
Mailing Address - Country:US
Mailing Address - Phone:816-220-3807
Mailing Address - Fax:
Practice Address - Street 1:9001 S LITCHFORD RD
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8115
Practice Address - Country:US
Practice Address - Phone:816-220-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO7303173320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities