Provider Demographics
NPI:1568174993
Name:BYRD, KODILYNN (LMSW, MSW U/S)
Entity Type:Individual
Prefix:
First Name:KODILYNN
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:LMSW, MSW U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 W GENTRY AVE
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-2444
Mailing Address - Country:US
Mailing Address - Phone:918-926-6100
Mailing Address - Fax:
Practice Address - Street 1:422 W GENTRY AVE
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-2444
Practice Address - Country:US
Practice Address - Phone:918-926-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health