Provider Demographics
NPI:1538704002
Name:LYONS, KEITH EUEGENE (LCSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:EUEGENE
Last Name:LYONS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 PASEO SEA CLF UNIT 69
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-6342
Mailing Address - Country:US
Mailing Address - Phone:619-632-1002
Mailing Address - Fax:
Practice Address - Street 1:1205 PASEO SEA CLF UNIT 69
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-6342
Practice Address - Country:US
Practice Address - Phone:619-632-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA927241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical