Provider Demographics
NPI:1467232082
Name:LYONS, GRACE (MA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHOLOGY - WSU PSYCHOLOGY CLINIC
Mailing Address - Street 2:BOX #34
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-0007
Mailing Address - Country:US
Mailing Address - Phone:316-978-3212
Mailing Address - Fax:316-978-3086
Practice Address - Street 1:DEPARTMENT OF PSYCHOLOGY - WSU PSYCHOLOGY CLINIC
Practice Address - Street 2:BOX #34
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67260-0007
Practice Address - Country:US
Practice Address - Phone:316-978-3212
Practice Address - Fax:316-978-3086
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KSLMLP03234103TB0200X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling