Healthcare Provider Details

I. General information

NPI: 1649952581
Provider Name (Legal Business Name): JENNIFER S. LYONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 N NEW BALLAS RD
CREVE COEUR MO
63141-6737
US

IV. Provider business mailing address

806 CARILLON CT
CREVE COEUR MO
63141-6316
US

V. Phone/Fax

Practice location:
  • Phone: 314-499-9144
  • Fax:
Mailing address:
  • Phone: 314-303-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: