Provider Demographics
NPI:1336968577
Name:LYONS, BRITTANY (CADC-R, PWS)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:CADC-R, PWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21440 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2024
Mailing Address - Country:US
Mailing Address - Phone:502-741-0187
Mailing Address - Fax:
Practice Address - Street 1:21440 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2024
Practice Address - Country:US
Practice Address - Phone:971-610-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000109961175T00000X
ORT-24-4479101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist