Provider Demographics
NPI:1649407156
Name:BYRNE, DOROTHY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANN
Last Name:BYRNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 BULL MOUNTAIN CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-2401
Mailing Address - Country:US
Mailing Address - Phone:210-313-8377
Mailing Address - Fax:512-329-5657
Practice Address - Street 1:4805 BULL MOUNTAIN CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-2401
Practice Address - Country:US
Practice Address - Phone:210-313-8377
Practice Address - Fax:512-329-5657
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19854101YP2500X
TXDT05631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered