Provider Demographics
NPI:1447442272
Name:LYON, JENNIFER LEIGH (MHA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:LYON
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4123
Mailing Address - Country:US
Mailing Address - Phone:066-548-0720
Mailing Address - Fax:606-886-4433
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4022
Practice Address - Country:US
Practice Address - Phone:606-237-9873
Practice Address - Fax:606-237-9723
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health