Provider Demographics
NPI:1932801875
Name:LYONS-REYNOLDS, JOELENE
Entity type:Individual
Prefix:
First Name:JOELENE
Middle Name:
Last Name:LYONS-REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOELENE
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, QMHP
Mailing Address - Street 1:1100 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-3512
Mailing Address - Country:US
Mailing Address - Phone:541-670-2722
Mailing Address - Fax:
Practice Address - Street 1:2210 N ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6418
Practice Address - Country:US
Practice Address - Phone:541-883-1030
Practice Address - Fax:541-884-2338
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
OR23-QMHP-R-1866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health