Healthcare Provider Details

I. General information

NPI: 1891930574
Provider Name (Legal Business Name): CASSIE LEAH LYONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 OLIVE BLVD SUITE 600
SAINT LOUIS MO
63141-6393
US

IV. Provider business mailing address

29 WELLS RD
BUFFALO KY
42716-9114
US

V. Phone/Fax

Practice location:
  • Phone: 180-032-5398
  • Fax: 877-685-9880
Mailing address:
  • Phone: 270-528-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1120
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: