Healthcare Provider Details

I. General information

NPI: 1770333247
Provider Name (Legal Business Name): CHRISTA DANIELLE LYON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31ST MEDICAL GROUP/SGST UNIT 6180
APO AE
09604-6180
US

IV. Provider business mailing address

411 OAK ST
CINCINNATI OH
45219-2504
US

V. Phone/Fax

Practice location:
  • Phone: 43-430-5667
  • Fax:
Mailing address:
  • Phone: 513-984-1800
  • Fax: 513-984-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: