Provider Demographics
NPI:1083806426
Name:BYRNE, ATHENA
Entity Type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:
Last Name:BYRNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25190 HANCOCK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5947
Mailing Address - Country:US
Mailing Address - Phone:951-239-8280
Mailing Address - Fax:951-239-8284
Practice Address - Street 1:25190 HANCOCK AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5947
Practice Address - Country:US
Practice Address - Phone:951-239-8280
Practice Address - Fax:951-239-8284
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93538106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist