Provider Demographics
NPI:1023490794
Name:CENTRAL LYON YOUTH CONNECTIONS
Entity type:Organization
Organization Name:CENTRAL LYON YOUTH CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, LCSW
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:775-246-0320
Mailing Address - Street 1:P.O. BOX 1865
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403
Mailing Address - Country:US
Mailing Address - Phone:775-246-0320
Mailing Address - Fax:
Practice Address - Street 1:170 PIKE STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403
Practice Address - Country:US
Practice Address - Phone:775-246-0320
Practice Address - Fax:775-246-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6731-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health