Provider Demographics
NPI:1598872608
Name:BYRD, ELIZABETH B (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:BYRD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 YORK AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5128
Mailing Address - Country:US
Mailing Address - Phone:901-683-5511
Mailing Address - Fax:901-309-8784
Practice Address - Street 1:1677 YORK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5128
Practice Address - Country:US
Practice Address - Phone:901-274-1868
Practice Address - Fax:901-309-8784
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37064321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3987188Medicaid
TN3987188Medicaid