Basic Information
| Provider Information | |||||||||
| NPI: | 1669983656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | NATOCHA | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | X | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 206 | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998330206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077724963 | ||||||||
| FaxNumber: | 9077724964 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 2ND & GJOA | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998330206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077724963 | ||||||||
| FaxNumber: | 9077724964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2017 | ||||||||
| LastUpdateDate: | 10/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.