Individual
SAMANTHA DANIELLE LYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1043 JACK VEST DR, JOHNSON CITY, TN 37614-3761
(423) 439-4044
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3856
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q078517
—
TN
Enumeration date
07/14/2020
Last updated
01/18/2024
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