Provider Demographics
NPI:1669212916
Name:LYONS, TERESA ANDERSON (MED)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANDERSON
Last Name:LYONS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-6277
Mailing Address - Country:US
Mailing Address - Phone:214-415-1653
Mailing Address - Fax:469-762-8119
Practice Address - Street 1:2016 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6277
Practice Address - Country:US
Practice Address - Phone:214-415-1653
Practice Address - Fax:469-762-8119
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional