Provider Demographics
NPI:1982069019
Name:LYONS, RICHARD JR (BA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:LYONS
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37450 SCHOOLCRAFT
Mailing Address - Street 2:110
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48159
Mailing Address - Country:US
Mailing Address - Phone:313-544-6276
Mailing Address - Fax:
Practice Address - Street 1:37450 SCHOOLCRAFT RD
Practice Address - Street 2:110
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1082
Practice Address - Country:US
Practice Address - Phone:313-544-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$Medicaid