Healthcare Provider Details

I. General information

NPI: 1013279959
Provider Name (Legal Business Name): THE WILLOWS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8665 W FLAMINGO RD STE 2000
LAS VEGAS NV
89147-8621
US

IV. Provider business mailing address

874 SHIRLEY LN
BOULDER CITY NV
89005-3627
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-9755
  • Fax: 702-367-9089
Mailing address:
  • Phone: 702-735-9755
  • Fax: 702-367-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC20120612-2476
License Number StateNV

VIII. Authorized Official

Name: DR. LAWRENCE J LYON
Title or Position: DIRECTOR
Credential: PHD
Phone: 702-735-9755