Provider Demographics
NPI:1902816234
Name:LYONS, MICHAEL CAREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CAREY
Last Name:LYONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 LAMA RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2805
Mailing Address - Country:US
Mailing Address - Phone:269-382-1582
Mailing Address - Fax:
Practice Address - Street 1:4328 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5823
Practice Address - Country:US
Practice Address - Phone:269-375-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007494103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist