Healthcare Provider Details

I. General information

NPI: 1124383294
Provider Name (Legal Business Name): VALERIE JEAN LYONS LMHC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

5136 30TH AVE APARTMENT 4 C
WOODSIDE NY
11377-7952
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax: 212-477-0521
Mailing address:
  • Phone: 917-991-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001847-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: