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General NPI Number Information
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NPI Number | 1841482379
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Entity Type | Organization
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Legal Business Name | LYONS CLINICAL COUNSELING & ASSOCIATES, P.C.
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 1065 MARTIN LUTHER KING DR
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City | CENTRALIA
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State | IL
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Zip | 62801-3001
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Country | US
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Telephone | 618-545-0770
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Fax | 618-545-0754
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Provider Business Mailing Address
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Address Line | 2125 HORTENSE ST P.O. BOX 393
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City | MURPHYSBORO
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State | IL
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Zip | 62966-1749
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Country | US
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Telephone | 618-684-6000
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Fax | 618-684-2159
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Authorized Official
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Title or Position | PRESIDENT/THERAPIST
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Name | DR. ROGER K. LYONS
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Credential | D.MIN., L.C.P.C.
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Telephone | 618-252-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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