Provider Demographics
NPI:1932801875
Name:LYONS-REYNOLDS, JOELENE
Entity Type:Individual
Prefix:
First Name:JOELENE
Middle Name:
Last Name:LYONS-REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOELENE
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, QMHP, CHW
Mailing Address - Street 1:517 S GRAPE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3653
Mailing Address - Country:US
Mailing Address - Phone:541-670-2722
Mailing Address - Fax:
Practice Address - Street 1:201 W MAIN ST STE 4B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2734
Practice Address - Country:US
Practice Address - Phone:541-281-9026
Practice Address - Fax:541-635-2087
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000108432171M00000X
OR23-QMHP-R-1866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator