Provider Demographics
NPI:1033480389
Name:SALLYBYROM PLLC
Entity Type:Organization
Organization Name:SALLYBYROM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:BYROM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT-ASSOCIATE
Authorized Official - Phone:512-695-8979
Mailing Address - Street 1:8500 N MOPAC EXPY STE 501
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8347
Mailing Address - Country:US
Mailing Address - Phone:512-695-8979
Mailing Address - Fax:
Practice Address - Street 1:8500 N MOPAC EXPY STE 501
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8347
Practice Address - Country:US
Practice Address - Phone:512-695-8979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63448101YP2500X
TX201245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty