| Lyons Center, Llc | |
|
110 Kellwood Dr Ste 200a Perry GA 31069-3263 | |
| (478) 227-0779 | |
| (478) 345-8758 |
| Full Name | Lyons Center, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 110 Kellwood Dr Ste 200a, Perry, Georgia |
| Authorized Official Name and Position | Bettina Rae Lyons (OWNER) |
| Authorized Official Contact | 4782270779 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lyons Center, Llc 110 Kellwood Dr Ste 200a Perry GA 31069-3263 Ph: (478) 227-0779 | Lyons Center, Llc 110 Kellwood Dr Ste 200a Perry GA 31069-3263 Ph: (478) 227-0779 |
| NPI Number | 1285242099 |
|---|---|
| Provider Enumeration Date | 07/17/2020 |
| Last Update Date | 07/17/2020 |
| Certification Date | 07/17/2020 |
| Medicare PECOS PAC ID | 3375983950 |
|---|---|
| Medicare Enrollment ID | O20240430001160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285242099 | NPI | - | NPPES |
| 1427217132 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Bettina Rae Lyons |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1427217132 PECOS PAC ID: 4284074865 Enrollment ID: I20240430001505 |
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