Provider Demographics
NPI:1598112245
Name:BYRD, KIMBERLY JILL (LMSW)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JILL
Last Name:BYRD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6997 CRANBERRY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4417
Mailing Address - Country:US
Mailing Address - Phone:248-321-0445
Mailing Address - Fax:
Practice Address - Street 1:6997 CRANBERRY LAKE RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4417
Practice Address - Country:US
Practice Address - Phone:248-321-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087311104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker