Provider Demographics
NPI:1558787622
Name:LYONS, SHENIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHENIA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-2153
Mailing Address - Country:US
Mailing Address - Phone:601-941-3683
Mailing Address - Fax:
Practice Address - Street 1:665 HIGHWAY 51 STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2136
Practice Address - Country:US
Practice Address - Phone:601-707-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS52 917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical