Provider Demographics
NPI:1952648271
Name:LYON, MCCALL BOWCUT (PSYD)
Entity Type:Individual
Prefix:
First Name:MCCALL
Middle Name:BOWCUT
Last Name:LYON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:MCCALL
Other - Middle Name:
Other - Last Name:BOWCUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 S 400 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2908
Mailing Address - Country:US
Mailing Address - Phone:801-582-5534
Mailing Address - Fax:
Practice Address - Street 1:5242 S 4820 W
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-6422
Practice Address - Country:US
Practice Address - Phone:801-966-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
UT9533115-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health