Provider Demographics
NPI:1508946559
Name:LYONS, RUTH ELLEN (LISW - S)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:LYONS
Suffix:
Gender:F
Credentials:LISW - S
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ELLEN
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5595 STATE ROUTE 47 E
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9542
Mailing Address - Country:US
Mailing Address - Phone:616-570-4211
Mailing Address - Fax:614-717-4427
Practice Address - Street 1:815 W BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1478
Practice Address - Country:US
Practice Address - Phone:614-717-0822
Practice Address - Fax:614-717-4427
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC114741041C0700X
MI68010671471041C0700X
OHI.10915821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0348011Medicaid