Provider Demographics
NPI:1326196783
Name:LYONS, ROGER K (DMIN, LCPC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:K
Last Name:LYONS
Suffix:
Gender:M
Credentials:DMIN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:SPECIALISTS CLINIC
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-0526
Mailing Address - Country:US
Mailing Address - Phone:618-252-1722
Mailing Address - Fax:618-252-1355
Practice Address - Street 1:130 E CLARK ST
Practice Address - Street 2:SPECIALISTS CLINIC
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2700
Practice Address - Country:US
Practice Address - Phone:618-252-1722
Practice Address - Fax:618-252-1355
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL069480Medicare UPIN
IL08332005Medicare UPIN
IL9191812Medicare UPIN
IL240294Medicare UPIN