Provider Demographics
NPI:1023885795
Name:LYONS, JENNIFER (MSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34071 LA PLZ STE 140
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-5707
Mailing Address - Country:US
Mailing Address - Phone:949-373-5063
Mailing Address - Fax:
Practice Address - Street 1:34071 LA PLZ STE 140
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-5707
Practice Address - Country:US
Practice Address - Phone:949-306-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor