Provider Demographics
NPI:1720204985
Name:LYONS, SALLY TIP (LPC)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:TIP
Last Name:LYONS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3452
Mailing Address - Country:US
Mailing Address - Phone:248-678-1146
Mailing Address - Fax:586-759-4401
Practice Address - Street 1:26862 WOODWARD AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0958
Practice Address - Country:US
Practice Address - Phone:248-507-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional