Doctor Name: | MICHELLE LYON |
NPI Number: | 1033547534 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLPC |
License Number: | 6401013926 |
Business Practice Address: | 22800 Hall Rd Ste 240 Clinton Township, MI - 480364805 |
Business Phone Number: | 5176765405 |
Business Fax Number: | 5176765460 |
Mailing Address: | 585 Jewett Rd, MASON |
State: | MI |
Postal Code: | 488548729 |
Phone Number: | 5176765405 |
Fax Number: | 5176765460 |
NPI Enumeration Date: | 10/18/2013 |
NPI Last Update Date: | 03/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6401013926 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |