Provider Demographics
NPI:1649573965
Name:LYONS, BOBBY LEWIS (MS)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:LEWIS
Last Name:LYONS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 LAUREL RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-1700
Mailing Address - Country:US
Mailing Address - Phone:407-575-3497
Mailing Address - Fax:
Practice Address - Street 1:175 LAUREL RIDGE AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-1700
Practice Address - Country:US
Practice Address - Phone:407-575-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health