Provider Demographics
NPI:1639369093
Name:LYON, JOANNA (LCPC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SLOUGH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2002
Mailing Address - Country:US
Mailing Address - Phone:406-471-0350
Mailing Address - Fax:
Practice Address - Street 1:2245 W KOCH ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4010
Practice Address - Country:US
Practice Address - Phone:406-595-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MT1278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1278OtherSTATE OF MONTANA