Provider Demographics
NPI:1376961698
Name:LYONS CLOTFELTER, KATHLEEN L (LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:L
Last Name:LYONS CLOTFELTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3000 LENHART RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-9203
Mailing Address - Country:US
Mailing Address - Phone:217-698-7150
Mailing Address - Fax:
Practice Address - Street 1:3000 LENHART RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-9203
Practice Address - Country:US
Practice Address - Phone:217-698-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional