Provider Demographics
NPI:1326496423
Name:LYON, JAMES CHADWICK (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CHADWICK
Last Name:LYON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 COVERT AVE
Mailing Address - Street 2:SUITE 217B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-5617
Mailing Address - Country:US
Mailing Address - Phone:812-213-7314
Mailing Address - Fax:812-485-1455
Practice Address - Street 1:4770 COVERT AVE
Practice Address - Street 2:SUITE 217B
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-5617
Practice Address - Country:US
Practice Address - Phone:812-213-7314
Practice Address - Fax:812-485-1455
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007463A1041C0700X
HILCSW-45741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ3093001Medicare PIN