Provider Demographics
NPI:1710623756
Name:BYERS, MARQUISE DEMONE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARQUISE
Middle Name:DEMONE
Last Name:BYERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GRAYMOOR LN
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1204
Mailing Address - Country:US
Mailing Address - Phone:773-603-0782
Mailing Address - Fax:
Practice Address - Street 1:111 GRAYMOOR LN
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1204
Practice Address - Country:US
Practice Address - Phone:773-603-0782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490228141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty