Provider Demographics
NPI:1548249923
Name:LYONS, GORDON J (LSCSW, BCD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:J
Last Name:LYONS
Suffix:
Gender:M
Credentials:LSCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9379 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2231
Mailing Address - Country:US
Mailing Address - Phone:913-250-5189
Mailing Address - Fax:
Practice Address - Street 1:EDIS ZAMA/ATSUGI
Practice Address - Street 2:SAGAMIHARA DHA
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343
Practice Address - Country:US
Practice Address - Phone:315-267-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 21111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical