Provider Demographics
NPI:1073399986
Name:BYRD, JONI (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ENCHANTMENT FALLS LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-0204
Mailing Address - Country:US
Mailing Address - Phone:850-630-6687
Mailing Address - Fax:
Practice Address - Street 1:4102 W HIGHWAY 390
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4580
Practice Address - Country:US
Practice Address - Phone:850-890-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health