Provider Demographics
NPI:1235549007
Name:BYRD, YVONNE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113B EDNA
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-7875
Mailing Address - Country:US
Mailing Address - Phone:573-289-5439
Mailing Address - Fax:
Practice Address - Street 1:13160 COUNTY ROAD 3610
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014000732101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor