Basic Information
| Provider Information | |||||||||
| NPI: | 1689022527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | WARMETRIS | ||||||||
| MiddleName: | DA'JON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MINDEN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710553363 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5902 BUNCOMBE ROAD | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711293363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186708898 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2016 | ||||||||
| LastUpdateDate: | 12/30/2016 | ||||||||
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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 | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.