Provider Demographics
NPI:1346597614
Name:KEITH LYONS COUNSELING LCSW PLLC
Entity Type:Organization
Organization Name:KEITH LYONS COUNSELING LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:516-730-6124
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-0090
Mailing Address - Country:US
Mailing Address - Phone:516-730-6124
Mailing Address - Fax:
Practice Address - Street 1:555 BROADHOLLOW RD
Practice Address - Street 2:SUITE 216
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-5078
Practice Address - Country:US
Practice Address - Phone:516-730-6124
Practice Address - Fax:631-759-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0775006-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty