Healthcare Provider Details

I. General information

NPI: 1548494214
Provider Name (Legal Business Name): LARA LYONS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N BETTIS ST
POCAHONTAS AR
72455-3301
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 870-609-0034
  • Fax: 870-609-0036
Mailing address:
  • Phone: 866-972-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6936-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: