Provider Demographics
NPI:1730588435
Name:LYONS, MARY CHRISTINE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHRISTINE
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JD
Mailing Address - Street 1:1205 4TH ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3707
Mailing Address - Country:US
Mailing Address - Phone:305-292-6723
Mailing Address - Fax:
Practice Address - Street 1:1205 4TH ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3707
Practice Address - Country:US
Practice Address - Phone:305-292-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)