Provider Demographics
NPI:1578621488
Name:BYRD, SUSAN R (MA,LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
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 1:14902 PRESTON RD STE 404 # 302
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9105
Mailing Address - Country:US
Mailing Address - Phone:214-796-6177
Mailing Address - Fax:972-774-0544
Practice Address - Street 1:14114 DALLAS PKWY STE 260
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-1316
Practice Address - Country:US
Practice Address - Phone:972-774-0221
Practice Address - Fax:972-774-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health