Provider Demographics
NPI:1629371133
Name:LYONS, LATOIA ODESSA
Entity Type:Individual
Prefix:
First Name:LATOIA
Middle Name:ODESSA
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19336 TILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2430
Mailing Address - Country:US
Mailing Address - Phone:323-635-8180
Mailing Address - Fax:
Practice Address - Street 1:19336 TILLMAN AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2430
Practice Address - Country:US
Practice Address - Phone:323-635-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health