Provider Demographics
NPI:1902130123
Name:LYON, SHANNON D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:D
Last Name:LYON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:D
Other - Last Name:SAGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-0435
Mailing Address - Country:US
Mailing Address - Phone:435-224-3213
Mailing Address - Fax:
Practice Address - Street 1:66 W VINE ST STE B
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2185
Practice Address - Country:US
Practice Address - Phone:435-241-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7047395-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker