Healthcare Provider Details

I. General information

NPI: 1376000190
Provider Name (Legal Business Name): KAYELEY ELISABETH LYONS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PARTRIDGE DR STE 110
VENTURA CA
93003-0714
US

IV. Provider business mailing address

1001 PARTRIDGE DR STE 110
VENTURA CA
93003-0714
US

V. Phone/Fax

Practice location:
  • Phone: 424-284-2440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: