MEDICARE: GINA LYONS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY-9123	CA

General Provider Information

NPI Number	:	1396543484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA LYONS PH.D.

Provider Business Mailing Address
First Line	:	5158 CLARETON DR.
Second Line	:	#1464
City	:	AGOURA HILLS
State	:	CA
Zip	:	91376
Country	:	US
Telephone Number	:	818-346-7259
Fax Number	:

Provider Business Practice Location Address
First Line	:	5158 CLARETON DR.
Second Line	:	#1464
City	:	AGOURA HILLS
State	:	CA
Zip	:	91376
Country	:	US
Telephone Number	:	818-346-7259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	03/04/2025

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