MEDICARE: DR. RICHARD SCOTT LYON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC28574	CA

General Provider Information

NPI Number	:	1164607917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD SCOTT LYON PH.D.

Provider Business Mailing Address
First Line	:	1000 E WALNUT ST
Second Line	:	SUITE 225
City	:	PASADENA
State	:	CA
Zip	:	91106-1452
Country	:	US
Telephone Number	:	818-957-5750
Fax Number	:	626-568-0340

Provider Business Practice Location Address
First Line	:	1000 E WALNUT ST
Second Line	:	SUITE 225
City	:	PASADENA
State	:	CA
Zip	:	91106-1452
Country	:	US
Telephone Number	:	818-957-5750
Fax Number	:	626-568-0340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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