Provider Demographics
NPI:1689008922
Name:BYRD, KRISTA JOI (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:JOI
Last Name:BYRD
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23020 GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2453
Mailing Address - Country:US
Mailing Address - Phone:248-730-2352
Mailing Address - Fax:
Practice Address - Street 1:23020 GARDNER ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2453
Practice Address - Country:US
Practice Address - Phone:248-730-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801090900OtherSOCIAL WORK LICENSE