Provider Demographics
NPI:1578663175
Name:BYRD, MARY D (LMHP, PC, LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:D
Last Name:BYRD
Suffix:
Gender:F
Credentials:LMHP, PC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16023 LINDENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-7443
Mailing Address - Country:US
Mailing Address - Phone:402-651-4673
Mailing Address - Fax:
Practice Address - Street 1:1710 N 144TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4715
Practice Address - Country:US
Practice Address - Phone:402-651-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1258101Y00000X
NE819101Y00000X
NE1180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025123100Medicaid