MEDICARE: ASHLEY JANE-MARIE LYON MA, LPC, ATR

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	101Y00000X	Counselor	6401013124	MI

General Provider Information

NPI Number	:	1972867109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY JANE-MARIE LYON MA, LPC, ATR

Provider Business Mailing Address
First Line	:	1251 MALLOW ST
Second Line	:
City	:	WOLVERINE LAKE
State	:	MI
Zip	:	48390-1934
Country	:	US
Telephone Number	:	734-718-2261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 MALLOW ST
Second Line	:
City	:	WOLVERINE LAKE
State	:	MI
Zip	:	48390-1934
Country	:	US
Telephone Number	:	734-718-2261
Fax Number	:

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

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	01/16/2023

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