Basic Information
| Provider Information | |||||||||
| NPI: | 1972867109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | JANE-MARIE | ||||||||
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| Credential: | MA, LPC, ATR, CAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6633 STONY CREEK | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347697366 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7300 DIXIE HWY STE 1000 | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483465105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489222300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2012 | ||||||||
| LastUpdateDate: | 11/24/2017 | ||||||||
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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 | C-03356 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101Y00000X | 6401013124 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.