Healthcare Provider Details

I. General information

NPI: 1679335590
Provider Name (Legal Business Name): LYON THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 E RIVERPARK LN STE 100
BOISE ID
83706-4000
US

IV. Provider business mailing address

3160 W FOXTROTTER DR
MERIDIAN ID
83646-7545
US

V. Phone/Fax

Practice location:
  • Phone: 208-859-6247
  • Fax:
Mailing address:
  • Phone: 120-885-9624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TARA ROCHELLE LYON
Title or Position: OWNER
Credential: LCSW
Phone: 208-859-6247