Provider Demographics
NPI:1396543484
Name:LYONS, GINA (PHD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5158 CLARETON DR.
Mailing Address - Street 2:#1464
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376
Mailing Address - Country:US
Mailing Address - Phone:818-346-7259
Mailing Address - Fax:
Practice Address - Street 1:5158 CLARETON DR.
Practice Address - Street 2:#1464
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91376
Practice Address - Country:US
Practice Address - Phone:818-346-7259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-9123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical