Provider Demographics
NPI:1740917566
Name:LYONS, ALEXIS
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14504-9768
Mailing Address - Country:US
Mailing Address - Phone:585-905-8563
Mailing Address - Fax:
Practice Address - Street 1:200 FAIRPORT RD
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1906
Practice Address - Country:US
Practice Address - Phone:585-524-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health