Healthcare Provider Details

I. General information

NPI: 1619771698
Provider Name (Legal Business Name): BREANNA LYONS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N PARK RD BLDG 5
WYOMISSING PA
19610-2945
US

IV. Provider business mailing address

220 N PARK RD BLDG 5
WYOMISSING PA
19610-2945
US

V. Phone/Fax

Practice location:
  • Phone: 610-609-1688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020589
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: