Provider Demographics
NPI:1588046486
Name:LYON, DARCY (MFT)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 NE 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6502
Mailing Address - Country:US
Mailing Address - Phone:503-975-2685
Mailing Address - Fax:
Practice Address - Street 1:811 NW 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1401
Practice Address - Country:US
Practice Address - Phone:971-266-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81222106H00000X
ORT1027106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist