Provider Demographics
NPI:1598933384
Name:BYRD, DELIZ JIVON (MS)
Entity Type:Individual
Prefix:
First Name:DELIZ
Middle Name:JIVON
Last Name:BYRD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DELIZ
Other - Middle Name:JIVON
Other - Last Name:MURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-0688
Mailing Address - Country:US
Mailing Address - Phone:620-331-1748
Mailing Address - Fax:620-332-1940
Practice Address - Street 1:3751 W MAIN ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-8446
Practice Address - Country:US
Practice Address - Phone:620-331-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4596101YP2500X
KS2374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional