Provider Demographics
NPI:1548470214
Name:BACCHUS STEUBER, LYRIS DEANNA (LMFT)
Entity type:Individual
Prefix:MS
First Name:LYRIS
Middle Name:DEANNA
Last Name:BACCHUS STEUBER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 DIANE CT
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3023
Mailing Address - Country:US
Mailing Address - Phone:407-417-7770
Mailing Address - Fax:
Practice Address - Street 1:515 HARLEY LESTER LN
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6129
Practice Address - Country:US
Practice Address - Phone:407-417-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist