Provider Demographics
NPI:1215214986
Name:BYRNE, PETER M (PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:BYRNE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 M ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3840
Mailing Address - Country:US
Mailing Address - Phone:801-363-9017
Mailing Address - Fax:801-363-9022
Practice Address - Street 1:24 M ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3840
Practice Address - Country:US
Practice Address - Phone:801-363-9017
Practice Address - Fax:801-363-9022
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2771533-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist