Provider Demographics
NPI:1992859912
Name:LYON, JENNIFER ELAINE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:LYON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELAINE
Other - Last Name:BRUCE ARVONEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:22 LOBELIA CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8241
Mailing Address - Country:US
Mailing Address - Phone:530-828-6861
Mailing Address - Fax:
Practice Address - Street 1:130 YELLOWSTONE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5884
Practice Address - Country:US
Practice Address - Phone:530-879-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA81344OtherMEDI-CAL BILLING NUMBER
CA46888OtherMFC
CA80614OtherMEDI-CAL BILLING NUMBER