Provider Demographics
NPI:1548453384
Name:LYONS, RONALD D (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:D
Last Name:LYONS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 MARTIN LUTHER KING DR
Mailing Address - Street 2:P.O. BOX 1241
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3001
Mailing Address - Country:US
Mailing Address - Phone:618-545-0770
Mailing Address - Fax:618-545-0754
Practice Address - Street 1:1065 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3001
Practice Address - Country:US
Practice Address - Phone:618-545-0770
Practice Address - Fax:618-545-0754
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.013219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health