Provider Demographics
NPI:1801854237
Name:BYRD, PAUL BRUCE (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BRUCE
Last Name:BYRD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 S SCENIC BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-4704
Mailing Address - Country:US
Mailing Address - Phone:509-570-6575
Mailing Address - Fax:
Practice Address - Street 1:2315 S SCENIC BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-4704
Practice Address - Country:US
Practice Address - Phone:509-570-6575
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT308375-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling