Provider Demographics
NPI:1841482379
Name:LYONS CLINICAL COUNSELING & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LYONS CLINICAL COUNSELING & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:K
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN, LCPC
Authorized Official - Phone:618-252-1722
Mailing Address - Street 1:2125 HORTENSE ST
Mailing Address - Street 2:P.O. BOX 393
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-1749
Mailing Address - Country:US
Mailing Address - Phone:618-684-6000
Mailing Address - Fax:618-684-2159
Practice Address - Street 1:1065 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3001
Practice Address - Country:US
Practice Address - Phone:618-545-0770
Practice Address - Fax:618-545-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty