MEDICARE: STACY ANN LYONS PMHNP-BC, LPC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP95023711	CA
2	101YM0800X	Mental Health Counselor	LPC-17363	AZ
3	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN215578	AZ
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP8866	AZ

General Provider Information

NPI Number	:	1588801641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY ANN LYONS PMHNP-BC, LPC

Provider Business Mailing Address
First Line	:	222 PEVELY FARMS DR
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-1618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8383 WILSHIRE BLVD STE 602
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2425
Country	:	US
Telephone Number	:	800-955-0167
Fax Number	:	800-452-1686

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

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	12/08/2025

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