Individual
JESSE LA RAY WAYNE LYONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
661 TAYLOR ST, PORT ORCHARD, WA 98366-4300
(360) 337-5753
(888) 834-8027
Mailing address
614 DIVISION ST # MS -19, PORT ORCHARD, WA 98366-4614
(360) 337-5753
(888) 834-8027
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61212988
WA
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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