Provider Demographics
NPI:1043426752
Name:LOY, BYRON (LCPC, PLPC, CRADC)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:LOY
Suffix:
Gender:M
Credentials:LCPC, PLPC, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N RUBY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1926
Mailing Address - Country:US
Mailing Address - Phone:618-398-4226
Mailing Address - Fax:618-398-1759
Practice Address - Street 1:125 N RUBY LN
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1926
Practice Address - Country:US
Practice Address - Phone:618-398-4226
Practice Address - Fax:618-398-1759
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001482101YM0800X
MO2003031617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health