Jesse La Ray Wayne Lyons, SUDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP61648364 Issued in WA

Practice address

1026 Sidney Ave
Port Orchard, WA 98366-4214

Phone

(360) 337-5753

Fax

(888) 834-8027

NPI assigned

Sep 18, 2023

Last updated

May 26, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1619755931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 DIVISION ST # MS -19",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983664614",
            "telephone_number": "360-337-5753",
            "fax_number": "888-834-8027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 SIDNEY AVE",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983664214",
            "telephone_number": "360-337-5753",
            "fax_number": "888-834-8027"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "661 Taylor St",
            "address_purpose": "LOCATION",
            "city": "Port Orchard",
            "state": "WA",
            "postal_code": "983664300",
            "country_code": "US",
            "telephone_number": "360-337-5753",
            "fax_number": "888-834-8027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYONS",
        "first_name": "JESSE",
        "middle_name": "LA RAY WAYNE",
        "name_prefix": "Mr.",
        "credential": "SUDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-18",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP61648364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Lucas
• Andrew James Luk, MD, MPH
• Luminosity Medical Allaince, PLLC
• Kelli Lyles, MA
• Sandra Lee Lynam, PTA
• Suzanne Michele Lysobey, ARNP
• Brad R. Mackinnon, M.D.
• Merideth Michelle Macrae, OTR/L
• Mary Wairimu Maina
• Prashant P Makadia, DDS

• Addiction (Substance Use Disorder) Counselor in Port Orchard, WA
• Providers in Port Orchard, 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 May 26, 2026; 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.