Provider Demographics
NPI:1427217132
Name:LYONS, BETTINA RAE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:RAE
Last Name:LYONS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2404
Mailing Address - Country:US
Mailing Address - Phone:478-227-0779
Mailing Address - Fax:470-290-6429
Practice Address - Street 1:103 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2404
Practice Address - Country:US
Practice Address - Phone:478-227-0779
Practice Address - Fax:470-290-6429
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC00987101YM0800X, 101YP2500X
GAMFT002058106H00000X
GAAMFT000771106H00000X
GAMFT001081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional