Provider Demographics
NPI:1770515470
Name:LYON, DEBORAH LEE (DDS MFT INTERN)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEE
Last Name:LYON
Suffix:
Gender:F
Credentials:DDS MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 SEE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-8008
Mailing Address - Country:US
Mailing Address - Phone:805-543-6050
Mailing Address - Fax:805-595-7885
Practice Address - Street 1:1022 MILL ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2784
Practice Address - Country:US
Practice Address - Phone:805-441-6051
Practice Address - Fax:805-595-7885
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF79810106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist