Provider Demographics
NPI:1528412566
Name:BYRD, ANGELA (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-0833
Mailing Address - Country:US
Mailing Address - Phone:817-919-7788
Mailing Address - Fax:
Practice Address - Street 1:1452 HUGHES RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9221
Practice Address - Country:US
Practice Address - Phone:682-503-1788
Practice Address - Fax:817-508-1788
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64666101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX815224890Medicaid