Provider Demographics
NPI:1518317601
Name:LYON, KARIN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 HILO AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5622
Mailing Address - Country:US
Mailing Address - Phone:715-641-0097
Mailing Address - Fax:
Practice Address - Street 1:3564 ROLLING VIEW DR STE D
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-7003
Practice Address - Country:US
Practice Address - Phone:715-641-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health