Kenneth Robert Lyons, MS, SUDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP61249696 Issued in WA

Practice address

3639 MLK Jr Way S
Seattle, WA 98144

Phone

(206) 805-8972

NPI assigned

Jun 15, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1124558614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3639 MLK JR WAY SOUTH",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3639 MLK JR WAY S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98144",
            "telephone_number": "206-805-8972"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16549 Aurora Ave N",
            "address_purpose": "LOCATION",
            "city": "Shoreline",
            "state": "WA",
            "postal_code": "981335308",
            "country_code": "US",
            "telephone_number": "206-533-2600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYONS",
        "first_name": "KENNETH",
        "middle_name": "ROBERT",
        "credential": "MS, SUDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-15",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP61249696",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CO60906258",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG60475258",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2110425",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Lyons, DDS,MSD
• Heidi May Lyons, DPT
• Jasmyne Lyons, PMHNP-BC
• Jenna Lyons
• Jeznee Lyons, AC60707200
• Luke Richard Lyons, DPT
• Monica Lyons, OTD, OTR/L
• Zane Lyons, RN
• Kelly Nicole Lyp, ARNP-DNP
• Pollyann Sebrina Lysen-Halpern, ARNP

• Addiction (Substance Use Disorder) Counselor in Seattle, WA
• Providers in Seattle, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.