Provider Demographics
NPI:1780759217
Name:LYONS, BETH (PHD)
Entity type:Individual
Prefix:MRS
First Name:BETH
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:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:TN
Mailing Address - Zip Code:38029-0269
Mailing Address - Country:US
Mailing Address - Phone:901-371-0018
Mailing Address - Fax:901-373-9613
Practice Address - Street 1:65 GERMANTOWN CT STE 417
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4259
Practice Address - Country:US
Practice Address - Phone:901-371-0018
Practice Address - Fax:901-373-9613
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4076329OtherBCBS
TNR95580Medicare UPIN
TN4076329OtherBCBS