Provider Demographics
NPI:1790297562
Name:BYRD-JOSEPH, KRISTINA M (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:BYRD-JOSEPH
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 1:2770 MAIN ST STE 119
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4336
Mailing Address - Country:US
Mailing Address - Phone:312-373-0152
Mailing Address - Fax:
Practice Address - Street 1:2770 MAIN ST STE 119
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4336
Practice Address - Country:US
Practice Address - Phone:312-373-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490195051041C0700X
TX669991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149019505OtherSTATE LICENSE NUMBER
TX1538871082OtherNPI2