Healthcare Provider Details

I. General information

NPI: 1629795646
Provider Name (Legal Business Name): LYONS EMERGENCY ASSISTANCE FUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN ST
LYONS CO
80540-5042
US

IV. Provider business mailing address

PO BOX 324
LYONS CO
80540-0324
US

V. Phone/Fax

Practice location:
  • Phone: 720-612-9774
  • Fax:
Mailing address:
  • Phone: 720-612-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHERIE MAUREAUX
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-612-9774