Provider Demographics
NPI:1427066810
Name:LYONS, DEBORAH SUSAN (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUSAN
Last Name:LYONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 MEDICAL PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3335
Mailing Address - Country:US
Mailing Address - Phone:512-459-1272
Mailing Address - Fax:512-459-1515
Practice Address - Street 1:4310 MEDICAL PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3335
Practice Address - Country:US
Practice Address - Phone:512-459-1272
Practice Address - Fax:512-459-1515
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L05AOtherBLUE CROSS BLUE SHIELD
TX00L05AMedicare ID - Type Unspecified