Provider Demographics
NPI:1821403700
Name:LYONS, KRISTIN BRUNELL
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BRUNELL
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 1:220 BUSHWICK AVE
Mailing Address - Street 2:APT 3F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4459
Mailing Address - Country:US
Mailing Address - Phone:801-703-7416
Mailing Address - Fax:
Practice Address - Street 1:220 BUSHWICK AVE
Practice Address - Street 2:APT 3F
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:801-703-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health