Provider Demographics
NPI:1760546568
Name:LYONS, LAURA (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S JAMES ST
Mailing Address - Street 2:# 2
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2104
Mailing Address - Country:US
Mailing Address - Phone:231-845-2827
Mailing Address - Fax:231-480-0119
Practice Address - Street 1:216 S JAMES ST
Practice Address - Street 2:# 2
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2104
Practice Address - Country:US
Practice Address - Phone:231-845-2827
Practice Address - Fax:231-845-9767
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010634501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM84720Medicare ID - Type Unspecified